Chen Lisa Wen-Yu, Chang Tommy Nai-Jen, Lee Chin-Pang, Sung Cheyenne Wei-Hsuan, Cheng Chuan, Chang Kuo-Hsuan, Chao Yin-Kai
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital-Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Psychiatry, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.
JTCVS Tech. 2023 Jun 23;21:251-258. doi: 10.1016/j.xjtc.2023.05.022. eCollection 2023 Oct.
Endoscopic thoracic sympathectomy may be complicated by the onset of disabling compensatory sweating (CS). The objective of this case series is to report the 2-year outcomes after robotic sympathetic trunk reconstruction (STR) for the reversal of CS in patients who had undergone endoscopic thoracic sympathectomy.
We prospectively followed-up a total of 23 patients who had undergone robotic STR because of intolerable CS between October 2017 and January 2021. A visual analog scale ranging from 0 to 10 (with 10 indicating the highest degree) was used to assess the severity of CS at different anatomical locations, thermoregulatory alterations, and gustatory hyperhidrosis. Measurements were performed before STR and at 6-month and 2-year follow-up.
The mean age of the study participants was 43.3 ± 7.8 years, and 20 (87%) were men. The reversal procedure was performed after a mean of 19.6 ± 7.8 years from endoscopic thoracic sympathectomy. In all patients, nerve defects were successfully bridged using sural nerves (mean length, 9.7 cm on the right and 9.8 cm on the left). No cases of Horner syndrome were noted. At 6 postoperative months, the severity of CS decreased significantly at all body surface areas. The observed improvements were effectively maintained at 24 post-STR months. There was no evidence of either recurrent hyperhidrosis at the primary site or transition of CS to other anatomical locations. Similar improvements were evident for thermoregulatory alterations and gustatory hyperhidrosis.
Robotic STR is safe and effective in reversing intolerable CS after endoscopic thoracic sympathectomy.
内镜下胸交感神经切断术可能会并发致残性代偿性出汗（CS）。本病例系列的目的是报告机器人交感神经干重建（STR）治疗内镜下胸交感神经切断术后CS患者的2年疗效。
我们前瞻性随访了2017年10月至2021年1月期间因无法忍受的CS而接受机器人STR手术的23例患者。采用0至10分的视觉模拟量表（10分表示程度最高）评估不同解剖部位CS的严重程度、体温调节改变和味觉性多汗症。在STR术前以及术后6个月和2年进行测量。
研究参与者的平均年龄为43.3±7.8岁，其中20例（87%）为男性。逆转手术在内镜下胸交感神经切断术后平均19.6±7.8年进行。所有患者均使用腓肠神经成功桥接神经缺损（右侧平均长度为9.7 cm,左侧平均长度为9.8 cm）。未观察到霍纳综合征病例。术后6个月时，所有体表区域的CS严重程度均显著降低。STR术后24个月时，观察到的改善得到有效维持。没有证据表明原发部位复发性多汗症或CS转移至其他解剖部位。体温调节改变和味觉性多汗症也有类似改善。
机器人STR治疗内镜下胸交感神经切断术后无法忍受的CS安全有效。
