腋下单孔交感链切断术治疗手汗症

目的探讨胸腔镜经腋下单孔T3、T4交感神经链切断术治疗手汗症的治疗效果和技术要点。方法2008年5月至2010年8月采用胸腔镜经腋下单孔T3、T4交感神经链切断术治疗手汗症患者36例,通过分析临床指标,评价该术式的有效性、安全性。结果均通过腋下单孔完成手术,无延长及增加切口者。术后单侧气胸1例,无Homer’s综合征及其他严重并发症。36例手汗症状均完全缓解,轻度代偿性多汗13例（36．1％）,中度2例（5．56％）,无重度代偿性多汗。结论胸腔镜经腋下单孔T3、T4交感链切断术治疗手汗症是一种安全、有效、微创的手术方式。     

经乳晕单孔胸腔镜交感神经切断术治疗手汗症

目的探讨经乳晕单孔胸腔镜交感神经切断术治疗手汗症的可行性。方法 2013年1月~2014年1月行经乳晕单孔胸腔镜交感神经切断术12例,术前采用多汗症严重程度量表进行多汗症分级,其中3级4例,4级8例。使用5 mm胸腔镜,经乳晕作一6 mm切口,用电钩行T3、T4胸交感神经链切断术。结果 12例手术均顺利完成,手术时间(18.2±4.5)min,术中出血量5 ml,术后住院1~2日。12例术后随访12~18个月,平均14.5月,术后评级1级5例,2级7例。一过性代偿性多汗3例。结论经乳晕单孔胸腔镜胸交感神经切断术治疗手汗症具有可行性,但例数有限,有待进一步论证。     

胸腔镜双侧腋下单切口胸交感神经链切断术治疗手汗症

目的观察胸腔镜双侧腋下单切口胸交感神经链切断术治疗原发性手汗症的可行性和疗效。方法成都市第三人民医院胸外科自2012年8月至2013年4月收治手汗症患者19例,其中男7例、女12例,年龄24.7(15~33)岁,全组均在全身麻醉气管内插管、胸腔镜下行双侧胸交感神经链切断术治疗原发性手汗症。结果全组均顺利完成手术,平均手术时间28.4 min,术后平均住院时间1.6 d。术后随访17例,随访时间2~10个月,所有患者手部多汗症状全部消失,无霍纳综合征和血气胸等并发症。结论胸腔镜双侧腋下单切口胸交感神经链切断术治疗原发性手汗症创伤小、并发症少、安全可靠。     

单孔法胸腔镜下交感神经链切断术治疗原发性手汗症35例报告

目的探讨单孔法胸腔镜下胸交感神经链切断术治疗手汗症的可行性和安全性。方法 2008年1月～2010年10月应用单孔法胸腔镜下行胸交感神经链切断术治疗手汗症35例。术中准确定位T3和T4交感神经节位置,在同一10mm trocar内置入微型胸腔镜和电凝钩,在第3或第4肋骨头表面将交感神经链电灼切断,并沿该肋骨表面向外侧延伸2～3cm以切断可能存在的旁路上传神经纤维。分别于交感神经链切断前后记录掌温变化。结果 35例均在胸腔镜下完成单孔手术,未出现术后出血、切口感染、血气胸、心动过缓以及霍纳氏综合征等并发症。双侧手术时间25～56 min,平均32 min。掌温升高(2.5±0.6)℃。术后住院1～4 d,平均2.5 d。术后第2～3天出现轻度代偿性出汗3例,部位分别在背部和大腿,7～15 d自行缓解消失。35例术后随访1～34个月,平均20.4月,术后双手多汗症状完全消失,并由湿冷转为干燥,温暖而红润,有效率达100%(35/35);腋窝和足底多汗症状的缓解率分别达92.3%(24/26)和82.7%(24/29)。结论 单孔法胸腔镜下胸交感神经链切断术治疗原发性手汗症微创、安全简便、定位准确、疗效确切、切口隐蔽美观,符合美学要求,可在临床推广应用。     

不同平面胸交感神经链切断治疗手汗症的前瞻性随机对照研究

目的探讨胸腔镜下R2—4及R2—3交感神经链切断术治疗手汗症术后患者满意度差异性及相关因素分析。方法2008年8月至2010年8月116例严重手汗症患者行手术治疗,患者随机分为两组,行胸腔镜下R214交感神经链切断术称为R2—4组,行胸腔镜下R3—4交感神经链切断术称为R3—4组。所有患者均在气管内静吸复合麻醉、胸腔镜下行双侧交感神经链切断术,术后通过电话问卷方式对患者进行随访,评价手术疗效、副作用。结果所有患者术后手汗症状得到解决,术后两组患者生活质量评分表得分均明显降低,但两组患者之间术前及术后1个月、6个月和12个月评分均无明显差异（P=0．859,0．056,0．229,0．367）。单因素分析表明严重代偿性多汗与患者满意度在术后1个月、6个月和12个月均呈负相关（P=0．000,0．000,0．000）。术后1个月仅患者家族史与满意度相关fP：0．019）,术后6个月及术后12个月患者年龄、性别、病史、体重指数和不同切除平面均与患者满意度不相关fP〉0．05）。结论胸腔镜下R2—4及R2—3交感神经链切断术均是治疗手汗症安全有效的方法。降低交感神经链切除平面或减少切除范围不能增加患者满意度;术后严重代偿性多汗与术后患者满意度成负相关,家族史可能和术后患者满意度相关。     

剑突下单孔胸腔镜同期处理双侧胸部疾病的疗效分析

目的总结剑突下单孔胸腔镜同期处理双侧胸部疾病的临床疗效。方法回顾性分析2016年8月至2017年12月遵义医学院附属医院胸外科60例行剑突下单孔胸腔镜手术治疗的双侧胸部疾病患者的临床资料,其中男35例、女25例,年龄13～51(25.5±8.8)岁。40例手汗症,20例双侧肺大疱并一侧气胸发作。均采用剑突下单孔胸腔镜处理:36例手汗症行双侧交感神经R3切断术,1例行双侧交感神经R4切断术,另3例行双侧交感神经R3+R4切断术;20例肺大疱行双侧肺大疱切除及胸膜固定术。结果 55例患者术后1～4 d治愈出院。1例肺大疱术后切口感染并肺部感染,经抗炎、切口换药3周后痊愈出院;4例肺大疱术后切口乙级愈合,经换药1～2周痊愈。随访1～3个月,无气胸及手汗等复发。结论剑突下单孔胸腔镜同期处理双侧胸部简单疾病是一种安全可行的治疗方案,避免了同期双侧打孔的创伤,减轻了患者痛苦。     

胸腔镜胸交感神经切断术治疗原发性手汗症的临床分析

目的:分析胸腔镜下胸交感神经切断术治疗手汗症的临床经验。方法:回顾分析37例手汗症患者行胸腔镜胸交感神经切断术的临床资料。结果:37例手术均获成功,平均手术时间(双侧)45min,平均住院4.5d;术后3例发生皮下气肿,2例胸腔积液,均治愈。双手无汗1例,未进一步治疗。随访时间3～24个月,无复发。结论:胸腔镜胸交感神经切断术治疗手汗症疗效确切、创伤轻、安全性高。     

胸腔镜胸交感神经干切断术治疗原发性手汗症（附38例报告）

目的总结胸腔镜下胸交感神经干切断术治疗原发性手汗症的临床经验。方法回顾性分析2006年4月～2009年5月胸腔镜下胸交感神经链切断术治疗38例原发性手汗症的临床资料。结果 38例手术均获成功,手掌多汗症状立即消失,平均手术时间（双侧）42min,平均住院4.2 d;术后并气胸1例,胸腔积液2例,经胸腔穿刺治疗后均治愈。发生轻微的代偿性多汗2例。无霍纳氏综合征及死亡病例。随访12个月,均无复发。结论胸腔镜下胸交感神经链切断术是治疗原发性手汗症的一种安全、有效的微创治疗方法。     

3 mm胸腔镜联合免trocar电凝钩经乳晕切口治疗男性手汗症

目的探讨3 mm针式胸腔镜联合2 mm免trocar电凝钩经乳晕切口行胸交感神经链切断术治疗男性原发性手汗症(primary hyperhidrosis,PH)的可行性。方法 2016年6月～2018年2月对18例男性PH,3 mm胸腔镜经乳晕外侧缘做一3 mm切口,2 mm免trocar电凝钩经乳晕内侧缘行T_3、T_4胸交感神经链切断术。结果 18例均顺利完成手术,手术时间20～58 min,平均29. 4 min。出血量2～5 ml,平均2. 3 ml。术后住院1～3 d,平均1. 3 d。术后手汗症状均消失,12例轻度代偿性出汗,3例气胸,2例少量胸腔积液,13例切口感觉异常,5例切口轻度疼痛。18例术后随访1～19个月,平均11. 5月,均达到有效标准,未出现中重度代偿性出汗,手术切口甲级愈合,愈合后较隐蔽。结论 3 mm针式胸腔镜联合2 mm免trocar电凝钩经乳晕切口行胸交感神经链切断术治疗男性PH效果良好,安全,手术切口隐蔽,符合微创及美学要求,具有可行性。     

单孔法胸腔镜下胸交感神经链切断术治疗原发性手汗症

目的探讨单孔法胸腔镜下胸交感神经链切断术治疗原发性手汗症的疗效及安全性。方法收集80例原发性手汗症患者,均接受单孔法胸腔镜双侧T4节段交感神经链切断术,喉罩通气,静吸复合全麻,于T4水平切断交感神经链,同时切断旁路传导纤维。手术前后监测患侧手掌皮温,术后评估手术疗效。结果全组80例患者均顺利完成手术,无死亡及严重并发症发生;术后出现少量气胸3例,乳糜胸1例。手术有效率100%,23例手掌完全干燥,57例在精神紧张和(或)环境温度过高时掌心略潮湿。13例术后出现转移性出汗,其中,胸背部位11例,臀部和大腿内侧部位7例(5例同时存在胸背部出汗),症状均轻微,未对患者术后生活造成不良影响。77例患者对疗效非常满意,2例满意,1例不满意。结论单孔法胸腔镜下胸交感神经链切断术治疗手汗症安全、有效,操作简单、创伤小、不良反应轻微,符合美学要求、患者满意度高。     

二孔法胸腔镜下T_3胸交感神经链切断术治疗手汗症(附52例报告)

目的总结二孔法胸腔镜下T3胸交感神经链切断术治疗手汗症52例的临床经验。方法 2006年8月～2008年12月采用电视胸腔镜T3胸交感神经链切断术治疗手汗症。以掌侧皮肤温度较术前升高1～3℃以上及干燥温暖为有效,手掌皮肤温度较术前增加(1℃且仍为潮湿者为无效。结果 52例手术均获成功,术后患者手掌多汗症状消失,有效率为100%,术后掌温升高(2.6±0.7)℃。50例随访1.5～24个月,平均14.5月,无一例复发及严重代偿性多汗,轻度代偿性多汗6例,占12%(6/50)。结论二孔法电视胸腔镜下T3胸交感神经链切断术是治疗手汗症微创、安全和有效的方法 。     

胸腔镜视下双侧胸交感神经干切断治疗原发性手汗症的临床分析

目的 总结在胸腔镜视下行双侧胸交感神经干切断术治疗手汗症的临床经验并分析其可行性.方法 2006年至2010年,在胸腔镜视下行双侧部分胸交感干切断术治疗手汗症23例.在胸腔镜视下电灼切断胸交感神经干(胸2～胸3),每3个月随访,以掌侧皮肤温度较术前升高1℃以上及干燥温暖为有效,手掌皮肤温度较术前增加小于1℃且仍潮湿者为无效.结果 23例患者术后手掌多汗症状立即消失,4例有背部或足底轻度代偿性出汗,无中度及以上代偿性多汗或其余严重并发症.术后随访时间为3个月至3年,平均18个月,无手汗复发,全部有效.结论 胸腔镜视下交感神经干切断术是一种治疗手汗症的安全有效的方法,且不难为手外科医师所掌握.     

胸腔镜下胸交感神经干切断术治疗手汗症200例近远期随访报告

目的评价电视胸腔镜行双侧T2～T4交感神经干切断术治疗手汗症的结果、并发症及术后生活质量.方法200例术后患者采取门诊或电话随访,随访1～28个月,平均18.4月.结果200例中失访8例,随访192例术后手及腋窝多汗症状均消失,无一例复发.术后无严重并发症,主要并发症为转移代偿性多汗27.1%(52/192),气胸和肺不张各1例.其中女性及重度手汗症患者术后发生率稍高,与年龄无关.结论胸腔镜下T2～T4交感神经干切断术治疗手汗症有效、安全、可靠,提高了患者术后生活质量,患者对手术的满意度比较高.但是术前应对所有患者强调常见并发症特别是转移代偿性多汗发生的可能.     

The importance of classification in sympathetic surgery and a proposed mechanism for compensatory hyperhidrosis: experience with 464 cases

Background Compensatory hyperhidrosis is the most troublesome side effect and the leading cause of regret with sympathetic surgery. A new classification is proposed to make the procedure more selective and to minimize the side effects and regret rate. Also, a proposed mechanism for compensatory hyperhidrosis is discussed. Methods Between January 2002 and July 2003, 464 patients with various sympathetic disorders underwent thoracoscopic sympathectomy/sympathicotomy (ETS) or sympathetic block by clipping (ESB) at various levels according to the authors’ classification. The surgery was performed on an outpatient basis. The rates of success, compensatory hyperhidrosis, and regret were recorded. Results All the patients were followed up for 17 to 35 months. All excessive sweating was effectively stopped to varying degrees. The 25 patients with palmar hyperhidrosis who insisted on receiving ETS of T4 experienced no compensatory hyperhidrosis. Of the 54 patients with facial blushing who received ESB of T2, 23 experienced compensatory hyperhidrosis. Nine patients expressed regret and requested removal of the clips. Of the 33 patients with craniofacial hyperhidrosis who received ESB of T3, 9 experienced compensatory hyperhidrosis. Three expressed regret, and reverse procedures were performed. For 324 patients with palmar hyperhidrosis receiving ESB of T4, no compensatory hyperhidrosis was found. Only two expressed regret because of discomfort. No compensatory hyperhidrosis or regret was noted with 28 patients who received ESB of T5 for axillary sweating. There was no recurrence in the entire series. Conclusions Different procedures are recommended for different sympathetic disorders according to the classification. The higher the level of sympathetic ganglion blockade, the higher is the regret rate. Therefore, for T2 and T3 ganglion, endoscopic thoracic sympathetic block by the clipping method is strongly recommended because of its reversibility.     

Video-assisted thoracic surgery sympathectomy for hyperhidrosis

HYPOTHESIS: Video-assisted thoracic surgery sympathectomy is efficacious for patients with hyperhidrosis. DESIGN: An experience with patients undergoing bilateral video-assisted thoracic surgery sympathectomy was reviewed to evaluate the operative technique and to determine morbidity and outcomes. SETTING: Academic health center. PATIENTS: The cohort included 31 patients (22 women and 9 men). All but 2 patients were of Asian descent, and the average age was 24.9 years. All patients had palmar hyperhidrosis. Two patients also had craniofacial hyperhidrosis, and another 2 had pedal hyperhidrosis. INTERVENTIONS: Bilateral video-assisted thoracic surgery sympathectomy with resection of the second and third ganglia was performed in all patients. Small chest tubes were removed on the first postoperative day. In 30 patients, the procedures were simultaneous; and in 1, it was staged to accommodate lumbar sympathectomy for pedal disease. RESULTS: Perioperatively, no patients died. The only hospital complication was an intraoperative injury to an intercostal artery that required conversion to an open thoracotomy. The average hospital length of stay was 1.2 days (range, 1-3 days). No patient developed Horner syndrome. Long-term follow-up was 2.6 years (range, 3 months to 7 years). Both hands in all patients were warm and dry at the last follow-up, as were the face and scalp in the 2 with craniofacial hyperhidrosis. Ten patients (32%) experienced compensatory sweating, which improved within 6 months. CONCLUSIONS: In this experience, palmar hyperhidrosis is predominantly a disease of young Asian women. Simultaneous bilateral video-assisted thoracic surgery sympathectomy is effective and can be accomplished with minimal morbidity and a short hospitalization. Compensatory sweating occurs in a third of patients, but is generally self-limiting.     

Transumbilical thoracic sympathectomy with an ultrathin flexible endoscope in a series of 38 patients

Background

The newest trend in the field of thoracic surgery, thoracic natural orifice transluminal endoscopic surgery (NOTES), is still in the early stages of development and limited to animal experiments. Transumbilical endoscopic surgery could work as a viable intermediate step before pure NOTES. We describe our experiences performing transumbilical–diaphragmatic thoracic sympathectomy with an ultrathin flexible endoscope for palmar and axillary hyperhidrosis in human patients.

Methods

From April 2010 to January 2012, a total of 38 patients underwent transumbilical–diaphragmatic thoracic sympathectomy. Through the incision in the umbilicus, a newly developed long trocar was inserted into the abdominal cavity. An ultrathin endoscope was introduced through the long trocar and then passed through the rigid incision made in the left and right diaphragm and into the thoracic cavity. The ganglion was ablated at the desired thoracic level.

Results

Sympathectomy was performed successfully in all patients. Mean operation time was 68 ± 16 (range, 48–107) minutes. There was no mortality and no conversion to open surgery during the operation of any patient. At a median follow-up of 11 (range, 4–12) months after surgery, no diaphragmatic hernia was observed. The rate of palmar hyperhidrosis and axillary hyperhidrosis resolution was 100 and 75 %, respectively.

Conclusions

Transumbilical endoscopic thoracic sympathectomy is technically feasible and safe, which has the possible advantages of pure NOTES and can be performed in routine clinical practice.     

Endoscopic thoracic sympathectomy for treatment of essential hyperhidrosis syndrome: experience with 650 patients

Patients with essential hyperhidrosis (EH) syndrome may experience subjective suffering and social/occupational challenges. We examined the safety and efficacy of minimally invasive endoscopic surgery for treating EH. Single bilateral incisions, followed by endoscopic thoracic sympathectomy (ETS)-mediated bilateral ablation of the T2 sympathetic ganglia, were used to treat 650 patients with a primary diagnosis of palmar (90%) or facial hyperhidrosis (10%). Palmar and facial hyperhidrosis were resolved in 584 of 585 (>99%) and 62 of 65 (95%) patients, respectively. Surgery required less than 1 hour, and no patient experienced a life-threatening adverse event. Compensatory sweating was observed in 83% of patients and was considered mild or moderate in approximately 67% of those patients. Innovations in ETS have resulted in minimally invasive, highly efficient, safe treatment of EH. Surgery is minimally intrusive to patients, who were usually discharged within 2 hours after surgery and able to resume normal activities within 1 week.     

The long-term results of upper dorsal sympathetic ganglionectomy and endoscopic thoracic sympathectomy for palmar hyperhidrosis

To assess and compare the long-term results of upper dorsal sympathetic ganglionectomy (UDS) and endoscopic thoracic sympathectomy (ETS), we examined 84 patients who underwent UDS and 71 patients who underwent ETS for the treatment of palmar hyperhidrosis. The period of follow-up ranged from 37 to 228 months. The immediate success rate was 100% in the UDS group and 98.6% in the ETS group. Troublesome compensatory hyperhidrosis occurred in 67.8% of the UDS patients and 84.8% of the ETS patients; however, 55% of the UDS patients and 63% of the ETS patients felt satisfied with their operation. The main reasons for dissatisfaction were recurrence and compensatory hyperhidrosis. Interestingly, simultaneous cure of plantar hyperhidrosis occurred in 28 (40%) of the UDS patients and 28 (44%) of the ETS patients with concomitant plantar hyperhidrosis. ETS required both a shorter operation time and hospital stay than UDS. Thus, we now perform ETS as the treatment of choice because of its excellent illumination and adequate magnification via a minimally invasive approach. The use of ETS as the first choice of treatment for palmar hyperhidrosis is supported not only by the immediate results, complications, and cure of plantar hyperhidrosis, but also by the long-term results. Nevertheless, compensatory hyperhidrosis was also a major complication after ETS.