Kao M C, Lee W Y, Yip K M, Hsiao Y Y, Lee Y S, Tsai J C
Department of Surgery, College of Medicine, National Taiwan University, Taipei, Republic of China.
J Pediatr Surg. 1994 Mar;29(3):387-91. doi: 10.1016/0022-3468(94)90574-6.
Palmar hyperhidrosis (PH) often starts in childhood and can be a disabling condition for a significant number of young children at the age they begin primary school. There are few reports regarding the surgical treatment of PH in children. The authors report on 40 PH patients under 16 years of age treated with video thoracoscopic laser sympathectomy; there has been substantial experience with this procedure for the treatment of adults with PH. A satisfactory result, with very low morbidity, was achieved for all 40 children. The surgical technique is described briefly. With the technique, the proper sympathetic segment is visualized in almost all cases and then definitely ablated with a fiberoptic low-power laser while under the aid of sympathetic monitoring. Consequently, an adequate sympathectomy warranting a long-lasting therapeutic effect can be achieved without the need of tissue diagnosis. No case required conversion to open sympathectomy. Neither injury to the lung nor bleeding was encountered. Horner's syndrome did not occur in any case. Bilateral sympathectomy was accomplished generally within 30 minutes. All patients were discharged after an overnight stay and are doing well with normal activities. The most frequent complication was compensatory hyperhidrosis, which was tolerable after reassurance. Based on the accumulated experience, it is justified to recommend early surgery, with this refined technique, in cases of severe PH in children.
掌跖多汗症（PH）通常始于儿童期，对于许多刚开始上小学的幼儿来说，可能是一种致残性疾病。关于儿童PH手术治疗的报道很少。作者报告了40例16岁以下接受电视胸腔镜激光交感神经切除术治疗的PH患者；在治疗成人PH方面，该手术已有丰富经验。所有40名儿童均取得了满意的效果，发病率极低。简要描述了手术技术。采用该技术，几乎在所有病例中都能清晰看到合适的交感神经节段，然后在交感神经监测辅助下，用低功率光纤激光进行确切消融。因此，无需组织诊断就能实现充分的交感神经切除术，保证持久的治疗效果。无一例需要转为开放交感神经切除术。未出现肺损伤或出血情况。无一例发生霍纳综合征。双侧交感神经切除术一般在30分钟内完成。所有患者住院一晚后出院，日常活动良好。最常见的并发症是代偿性多汗症，经安抚后可耐受。基于积累的经验，对于儿童严重PH病例，采用这种改进技术推荐早期手术是合理的。
