Kao M C, Lin J Y, Chen Y L, Hsieh C S, Cheng L C, Huang S J
Department of Surgery, National Taiwan University Hospital, Taipei, ROC.
Ann Acad Med Singap. 1996 Sep;25(5):673-8.
Palmar hyperhidrosis (PH) is a common disorder in Taiwan. It often causes social embarrassment and occupational handicaps. So far, there has been no satisfactory treatment for PH. In 1990, we first developed a minimally invasive technique: video endoscopic sympathectomy to treat PH. The procedure has subsequently proven to be a standard treatment for PH. In this study, a survey of 9988 cases of PH patients from 17 hospitals in Taiwan treated by this method during the past 5 years is presented. Although there were some variations in the model of anaesthesia, technique and extent of sympathectomy, the postoperative results were generally satisfactory. Both sides of sympathectomy were mostly accomplished within half an hour in one stage. The operative scars were tiny and concealed in the axillary region. The patients were discharged from the hospital after an overnight stay. Complications such as pneumothorax, haemothorax (0.3%) or Horner's syndrome (0.1%) were rare. There was no surgical mortality in this series. The most common complication was compensatory hyperhidrosis which was usually mild to moderate and tolerable after reassurance. The recurrence rate of PH was approximately 1% in the first year and less than 3% during the 3 years of follow up. Intraoperative monitoring of palmar skin temperature (PST) was advocated to confirm an adequate sympathectomy warranting a definite result. En bloc ablation of T2 segment invariably resulted in a rise of PST to about 2 degrees C and was considered as an adequate extent of sympathectomy for PH. The refined technique was extended to treat young children with PH and patients with craniofacial hyperhidrosis. The therapeutic results were generally excellent with minimal morbidity and rare recurrence. It is concluded that video endoscopic en bloc T2 sympathectomy is a simple, minimally invasive and effective treatment for both adults and children with PH and also for patients with craniofacial hyperhidrosis.
手掌多汗症（PH）在台湾是一种常见病症。它常导致社交尴尬和职业障碍。到目前为止，对于PH尚无令人满意的治疗方法。1990年，我们首次开发了一种微创技术：电视胸腔镜交感神经切除术来治疗PH。该手术随后被证明是治疗PH的标准方法。在本研究中，呈现了对过去5年台湾17家医院采用此方法治疗的9988例PH患者的调查。尽管在麻醉方式、手术技术和交感神经切除范围上存在一些差异，但术后结果总体令人满意。双侧交感神经切除术大多在半小时内一次性完成。手术疤痕微小且隐藏在腋窝区域。患者术后过夜即可出院。气胸、血胸（0.3%）或霍纳综合征（0.1%）等并发症很少见。本系列中无手术死亡病例。最常见的并发症是代偿性多汗症，通常为轻至中度，经安抚后可耐受。PH的复发率在第一年约为1%，在3年随访期间低于3%。提倡术中监测手掌皮肤温度（PST）以确认交感神经切除术充分，从而保证确切疗效。T2节段整块切除总是会使PST升高约2摄氏度，这被认为是治疗PH的交感神经切除足够范围。该精细技术已扩展用于治疗患有PH的幼儿和头面部多汗症患者。治疗效果总体极佳，发病率极低且复发罕见。结论是电视胸腔镜T2节段整块交感神经切除术是一种治疗成人和儿童PH以及头面部多汗症患者的简单、微创且有效的方法。
