Mares A J, Steiner Z, Cohen Z, Finaly R, Freud E, Mordehai J
Department of Pediatric Surgery, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel.
J Pediatr Surg. 1994 Mar;29(3):382-6. doi: 10.1016/0022-3468(94)90573-8.
Primary palmar hyperhidrosis is part of a triad of palmar, plantar, and axillary hyperhidrosis of unknown etiology, affecting children, adolescents, and young adults. Sixty-seven children and young adolescents were operated on during a 10-year period. A total of 103 transaxillary upper thoracic sympathectomies (36 bilateral) were performed, with no mortality. The immediate postoperative course was uneventful in 90%; the other 10% had mostly minor problems. The average hospitalization period was 3 to 4 days. Total abolition of palmar sweating was achieved in all but two patients in whom some residual moisture remained. Long-term extreme satisfaction was reported by 64 of 67 patients (94%). One was moderately satisfied, and two were not satisfied because of excessive "compensatory" sweating elsewhere. Compensatory sweating of some degree was reported by 45% of patients but did not alter satisfaction. By further limiting ganglionectomy to just one ganglion (T2 or T3), compensatory sweating possibly may be reduced further. Early surgery for severe palmar hyperhidrosis will save a child many years of agony and social discomfort because all types of conservative therapy are ineffective and cause unnecessary delay. A limited transaxillary upper thoracic sympathectomy is presently the authors' preferred approach, although ablation via thoracoscopy should not be excluded as further experience is gained with this modality.
原发性手掌多汗症是病因不明的手掌、足底和腋窝多汗症三联征的一部分，影响儿童、青少年和年轻成年人。在10年期间，对67名儿童和青少年进行了手术。共进行了103例经腋窝上胸交感神经切除术（36例双侧），无死亡病例。90%的患者术后即刻病程平稳；另外10%的患者大多有轻微问题。平均住院时间为3至4天。除两名患者仍有一些残留汗液外，所有患者的手掌出汗均完全消除。67例患者中有64例（94%）报告长期极度满意。1例中度满意，2例因其他部位出现过度“代偿性”出汗而不满意。45%的患者报告有一定程度的代偿性出汗，但这并未改变满意度。通过进一步将神经节切除术限制在仅一个神经节（T2或T3），代偿性出汗可能会进一步减少。对于严重的手掌多汗症，早期手术将使儿童免于多年的痛苦和社交不适，因为所有类型的保守治疗均无效且会导致不必要的延误。目前，作者首选有限的经腋窝上胸交感神经切除术，不过随着对胸腔镜消融术经验的积累，也不应排除这种方法。
