Santos Tiago Silva, Bachichi Thiago Gangi, Joaquim Daniela Tamega, De Sousa Maria Helena, Vieira Ponte Eduardo, De Campos José Ribas Milanez, Marchi Evaldo
Department of Medicine and Surgery, Medicine College of Jundiaí, Rua Francisco Telles, Jundiaí, São Paulo, Brazil.
Thoracic Surgery, University of São Paulo Medical School, Cerqueira César, São Paulo, Brazil.
Interdiscip Cardiovasc Thorac Surg. 2025 Mar 5;40(3). doi: 10.1093/icvts/ivaf063.
Primary hyperhidrosis is a functionally and socially limiting condition. Thoracoscopic sympathectomy is an effective treatment for hyperhidrosis. However, post-sympathectomy compensatory sweating remains a challenge in clinical practice.
Record analysis of patients who underwent thoracoscopic sympathectomy between 2002 and 2020. Emphasis was given to demographic data, site of complaint, functional and social impairment, procedure performed, postoperative results and compensatory sweating.
A total of 820 patients were included (age 23.8 [7.3] years, body mass index-BMI 22.3 [3.0] kg/m2, 66.3% female). The palmoplantar (44.3%) and palmoplantar-axillary (41.6%) sites were the most affected, followed by the axillary (12.3%) and craniofacial sites (1.8%). On a 0-4 scale, functional impairment was significantly greater in the palmoplantar group (P < 0.001) and social impairment in the axillary, palmoplantar-axillary and craniofacial groups (P < 0.001). The degree of compensatory sweating after surgery was minimal in groups palmoplantar (74.9%), palmoplantar-axillary (70.4%), axillary (63.4%) and mild in the craniofacial group (66.7%). The bivariate analyses showed significant differences in the compensatory sweating variable for age, sex, BMI and site. The multiple analysis by logistic regression showed BMI, sex and the palmoplantar-axillary, axillary and craniofacial variables to be significant for compensatory sweating.
Thoracoscopic sympathectomy was an effective procedure for controlling primary focal hyperhidrosis, with tolerable compensatory sweating in the patients analysed in this study.
原发性多汗症是一种在功能和社交方面具有限制的病症。胸腔镜交感神经切除术是治疗多汗症的有效方法。然而，交感神经切除术后的代偿性出汗在临床实践中仍然是一个挑战。
对2002年至2020年间接受胸腔镜交感神经切除术的患者进行记录分析。重点关注人口统计学数据、主诉部位、功能和社交障碍、所实施的手术、术后结果以及代偿性出汗情况。
共纳入820例患者（年龄23.8[7.3]岁，体重指数-BMI为22.3[3.0]kg/m²，女性占66.3%）。手掌足底（44.3%）和手掌足底-腋窝（41.6%）部位受影响最为严重，其次是腋窝（12.3%）和颅面部部位（1.8%）。在0至4分的量表上，手掌足底组的功能障碍明显更大（P<0.001），腋窝、手掌足底-腋窝和颅面部组的社交障碍明显更大（P<0.001）。手掌足底组（74.9%）、手掌足底-腋窝组（70.4%）、腋窝组（63.4%）术后代偿性出汗程度最小，颅面部组（66.7%）为轻度。双变量分析显示，年龄、性别、BMI和部位在代偿性出汗变量方面存在显著差异。逻辑回归的多因素分析显示，BMI、性别以及手掌足底-腋窝、腋窝和颅面部变量对代偿性出汗具有显著意义。
胸腔镜交感神经切除术是控制原发性局灶性多汗症的有效方法，在本研究分析的患者中代偿性出汗可耐受。
