Drott C, Claes G, Olsson-Rex L, Dalman P, Fahlén T, Göthberg G
Department of Surgery, Borås Hospital, Sweden.
Br J Dermatol. 1998 Apr;138(4):639-43. doi: 10.1046/j.1365-2133.1998.02176.x.
Facial blushing is one of the cardinal symptoms of social phobia and has a strong negative impact on the quality of life. Traditional therapeutic options are psychotherapy and pharmacological treatment. The results of these treatments on facial blushing are poorly documented. To investigate whether endoscopic bilateral transection of the upper thoracic sympathetic chain is efficient in the treatment of facial blushing, 244 consecutive patients were treated with bilateral endoscopic transthoracic sympathicotomy (ETS). The results were evaluated by questionnaire and symptoms assessed with visual analogue scales (0-10). There was no mortality nor conversion to open surgery. No Horner's syndrome occurred. Two patients with postoperative pneumothorax were treated with intercostal drainage and one small pulmonary embolus was detected. The questionnaire was answered by 219 patients (90%) a mean (+/- SEM) of 8 months (+/- 9 days) after surgery. Facial blushing (mean +/- SEM) was reduced from 8.7 +/- 0.1 to 2.2 +/- 0.2, P < 0.0001, by the operation. Heart palpitations in stressful situations were also reduced (3.7 +/- 0.3 to 1.3 +/- 0.1, P < 0.0001). The quality of life was substantially improved. The main side-effect was redistribution of sweating from the upper to the lower part of the body. Increased sweating of the trunk occurred in 75% of the patients. Overall, 85% of the patients were satisfied with the result and 15% were to some degree dissatisfied, mainly due to insufficient effect, but only four patients (2%) regretted the operation. As this is an open study, the results must be viewed with caution. ETS, however, appears to be an efficient, safe and minimally invasive surgical method for the treatment of facial blushing.
面部潮红是社交恐惧症的主要症状之一，对生活质量有严重负面影响。传统的治疗方法是心理治疗和药物治疗。这些治疗对面部潮红的效果记录不佳。为了研究内镜下双侧上胸交感神经链切断术治疗面部潮红是否有效，对244例连续患者进行了双侧内镜下胸交感神经切断术（ETS）。通过问卷调查评估结果，并用视觉模拟量表（0-10）评估症状。无死亡病例，也未转为开放手术。未发生霍纳综合征。2例术后气胸患者接受了肋间引流治疗，检测到1例小的肺栓塞。219例患者（90%）在术后平均（±标准误）8个月（±9天）回答了问卷。手术使面部潮红（平均±标准误）从8.7±0.1降至2.2±0.2，P<0.0001。应激状态下的心悸也有所减轻（3.7±0.3至1.3±0.1，P<0.0001）。生活质量得到显著改善。主要副作用是出汗从身体上部重新分布到下部。75%的患者出现躯干出汗增加。总体而言，85%的患者对结果满意，15%的患者在某种程度上不满意，主要是因为效果不佳，但只有4例患者（2%）后悔接受手术。由于这是一项开放性研究，结果必须谨慎看待。然而，ETS似乎是一种治疗面部潮红的有效、安全且微创的手术方法。
