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首页> 中文期刊> 《中国微创外科杂志》 >胸交感神经切断术治疗原发性手汗症2206例：10年结果和分析

胸交感神经切断术治疗原发性手汗症2206例：10年结果和分析

         
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摘要

Objective To analyze the efficacy of endoscopic thoracic sympathotomy ( ETS) in the treatment of primary palmar hyperhidrosis (PPH). Methods From January 2003 to January 2013, we performed ETS to treat 2206 patients with PPH.We carried out a retrospective summary and analysis of clinical data of Group A ( non-reserved R2, R2 -R4 ablation ) and Group B (reserved R2, R3 or R4 ablation). Results All the operations were performed under thoracoscope , and no severe complications or mortality were found .Transient postoperative palmar sweating manifested in 25 patients within 1 week after surgery , which was resolved spontaneously within 1-2 weeks.Long-term follow-ups for 1-8 years (median, 4.5 years) were obtained for all the 2206 patients. All the patients had warm and dry palm and face at discharge , and the effective rate was 100%.Among them, 41.8% of patients experienced decreased axillary sweating and 29.3% of patients experienced decreased plantar sweating .Three patients experienced gustory hperhidrosis during 1 -2 months after operation , and the symptoms disappeared spontaneously after 1 year.Five cases experienced recurrent palmar hyperhidrosis 9 months to 5 years after operation , all of which were cured by reoperation . The compensatory hyperhidrosis (3 grades) was changed to transfer hyperhidrosis (TH), with patients divided into 4 grades, including 944 cases (42.8%) with GradeⅠor mild symptoms, 750 cases (34.0%) with GradeⅡor moderate symptoms, 42 cases (1.9%) with Grade Ⅲor severe symptoms, and 18 cases (0.8%) with Grade Ⅳ or extremely severe symptoms ( also known as incapacitating hyperhidrosis, IH).The overall rate of TH was 79.5%(1754/2206).All these 18 cases of IH were followed up for 1 -8 years (median,4.5 years), with only two cases improved.The satisfaction in therapeutic effect was 94.2%(487/517) in Group A, which was significantly lower than that in Group B [98.1%(1657/1689),Z=-4.704,P=0.000].The quality of life was significantly higher in Group B than that in Group A (Z=-5.425,P=0.000). Conclusions ETS is a safe and effective method of minimally invasive treatment for PPH.Reserving R2 during surgery and lowering the thoracic sympathotomy level (single ablation of R3 or R4) can significantly reduce the incidence of Grade Ⅲ-ⅣTH.Regarding the harmful effect of Grade ⅣIH, the indications of surgery are restrict.%目的探讨胸腔镜下胸交感神经切断术（ endoscopic thoracic sympathotomy ， ETS）治疗原发性手汗症（ primary palmar hyperhidrosis ，PPH）的效果。方法2003年1月～2013年1月我们施行ETS 治疗PPH 2206例，将不保留R2（切断R2～R4）和保留R2（单一切断R3或R4）分为A、B组进行回顾性比较。结果均在胸腔镜下完成手术，无手术死亡和严重并发症。25例术后1周内出现一过性手掌多汗，均于1～2周内消失。2206例随访1～8年，中位时间4．5年。所有患者手掌伴头面部多汗症状及手部皮肤症状全部治愈，有效率100％；伴腋窝（41．8％）和足底（29．3％）多汗症状得到改善。3例术后1～2个月发生味觉性多汗，均于1年后自愈；5例术后9个月～5年复发，经再次手术治愈。转移性多汗（ transfer hiperhidrosis ， TH）Ⅰ级或轻度944例（42．8％），Ⅱ级或中度750例（34．0％），Ⅲ级或重度42例（1．9％），Ⅳ级或极重度又称致残性多汗18例（0．8％），TH发生率79．5％（1754／2206）。致残性多汗18例，随访时间1～8年，中位时间4．5年，仅好转2例。 A、B组疗效满意度分别为94．2％（487／517）、98．1％（1657／1689），A组明显低于B组（Z＝－4．704，P＝0．000）。 B组生活质量分级明显优于A组（Z＝－5．425，P＝0．000）。结论 ETS是治疗PPH安全、有效的微创方法。保留R2，降低胸交感神经切断平面，即单一切断R3或R4能显著降低Ⅲ～Ⅳ级转移性多汗发生率。一旦发生致残性多汗，难以治愈且长期存在，对患者危害性极大，应严格掌握ETS适应证。

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  • 来源
    《中国微创外科杂志》 |2017年第2期|99-103|共5页
  • 作者

    涂远荣; 林敏; 陈剑锋; 李旭; 赖繁彩; 邱明链; 杜泉; 肖仁栋; 林剑波;

  • 作者单位

    福建医科大学附属第一医院胸外科;

    福州 350005;

    福建医科大学附属第一医院胸外科;

    福州 350005;

    福建医科大学附属第一医院胸外科;

    福州 350005;

    福建医科大学附属第一医院胸外科;

    福州 350005;

    福建医科大学附属第一医院胸外科;

    福州 350005;

    福建医科大学附属第一医院胸外科;

    福州 350005;

    福建医科大学附属第一医院胸外科;

    福州 350005;

    福建医科大学附属第一医院胸外科;

    福州 350005;

    福建医科大学附属第一医院胸外科;

    福州 350005;

  • 原文格式 PDF
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  • 关键词

    手汗症; 胸腔镜下胸交感神经切断术; 转移性多汗;

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