一孔法胸腔镜下交感神经切断术治疗手汗症疗效观察

目的观察一孔法胸腔镜下交感神经切断术治疗手汗症的疗效。方法采用一孔法行双侧胸腔镜胸交感神经节切断术治疗手汗症16例。术毕排出胸腔残余气体,不置胸腔引流管。结果本组患者术后手掌多汗症状均消失。无手术死亡。平均双侧手术时间39 min。平均随访2.1个月,无复发。结论一孔法腔镜胸交感神经切断术治疗手汗症疗效好。     

针型胸腔镜胸交感神经链切断术治疗手足多汗症(附237例报告)

目的探讨针型胸腔镜T3~4交感神经链切断术治疗手足多汗症的疗效和术后并发症的发生率。方法总结我科收治的237例多汗症病例。全部采用针型胸腔镜胸交感神经链切断术,对其进行随访,分析对手、足多汗的疗效及术后并发症的发生率。结果 237例手术全部成功,术后手多汗症状完全消失或明显缓解,治愈率100%。腋窝多汗及足底多汗缓解率分别为96.9%及77.2%。平均手术时间(38.4±17.3)min,术后平均住院日(3.4±0.7)d。轻-中度代偿性多汗发生率16.5%。无严重并发症。结论针型胸腔镜T3-4交感神经链切断术是治疗手汗症安全、有效、可靠的方法。     

胸腔镜下双侧胸交感神经链切除治疗手汗症的手术护理

目的探讨胸腔镜下胸交感神经链切断术治疗手汗症的手术护理方法。方法总结35例手汗症患者术前、术中及术后的心理护理、术前准备及术中配合等经验。结果术后手汗症状均消失,手术效果满意。结论有效的心理护理,充分的术前准备,密切的术中配合,可提高手术质量。     

纤支镜下胸交感神经链切断术治疗手汗症51例临床观察

目的探讨局麻纤支镜下胸交感神经切断术治疗手汗症的安全性和临床应用价值。方法对51例手汗症患者行局麻纤支镜下胸交感神经切断术治疗,记录手术完成情况、手术时间、并发症发生情况,住院费用,术后随访观察治疗效果。结果 51例均顺利完成手术,术中患者生命体征平稳,手术时间42~92min平均56min,无霍纳氏综合征和血胸等严重并发症发生,仅3例术后并发少量气胸;术后第三天恢复学习和工作,住院费明显降低。随访3~12个月,所有患者手部多汗症状完全消失,切口未见明显瘢痕,隐匿于腋毛内完全不可见。结论局麻纤支镜下胸交感神经切断术治疗手汗症安全有效,费用低,术后瘢痕小而隐匿,更加适合美容。     

电视胸腔镜下胸交感神经链切除术治疗原发性多汗症不同神经节段的选择

<正>交感神经切除术最早是由Alexander在1899年报道,当时主要用于治疗癫痫、突眼性甲状腺肿、白痴、青光眼等疾病,但其临床疗效不佳。后来又用于心绞痛、肢体血管痉挛、高血压和手足多汗症等疾病的治疗。Kotzareff〔1〕最早报道了交感神经链切断术治疗原发性手汗症的经验,但该项手术未能广泛开展。直到20世纪80年代电视胸腔镜进入胸外科后,使微创化的胸腔镜交感神经切除手术(TSS)极大地减少了手术创伤,从     

胸腔镜下手汗症治疗方法的改进与应用

目的：探讨改进后胸腔镜下手汗症治疗方法的临床效果。方法：采用改进胸腔镜下胸交感神经切断术治疗30例手汗症患者，其中电刀切断交感神经27例，钛夹钳夹3例；单纯切断第2交感神经11例，切断或钳夹第2、3交感神经19例。结果：30例患者术后手汗均消失，腋窝汗明显减少，无气胸、出血及Horner’s综合征等严重并发症。术后随访1～9个月，2例出现较严重代偿性多汗。结论：改进的手术方法具有操作简单、安全有效、创伤小、并发症少等特点，值得临床推广。     

手汗症胸交感神经链切断术后QT离散度的变化

目的探讨手汗症患者胸2～胸4交感神经链切断术后QT离散度(QTd)的变化。方法回顾性分析72例手汗症患者交感神经链切断术前后12导同步心电图的RR间期、QT间期、QTcd数值的变化。结果术后QT间期、RR间期较术前缩短,QT离散度较术前延长,P均<0.01。结论手汗症患者胸2～胸4交感神经链切断QT离散度的变化与交感神经有着内在联系。     

胸交感神经干切断术中运用单孔法胸腔镜的临床分析

目的研究单孔法胸腔镜在胸交感神经干切断术中的应用,以及比较单孔法和二孔法腹腔将的临床治疗效果。方法对我院68例运用胸腔镜对胸交感神经干切断术患者的临床资料进行分析,将其均分为两组,每组为34例患者,一组运用单孔法,另一组运用二孔法,术后对两组患者进行随访,对其术后效果以及出现并发症的几率进行对比分析。结果 68例患者的手术均在胸腔镜下完成,术后对所有患者均进行1～26个月不等的随访,平均时间为12.6个月。进行治疗后,所有患者的临床症状(手部多汗)均痊愈,有效率达到100%,对两组患者的手术所需时间、术中出血量、术后住院时间和术后有效率进行比较,未见明显差异。结论运用单孔法腹腔镜治疗胸交感神经干切断术的临床效果和二孔法的临床效果基本一致。     

胸腔镜下T3和T4不同节段双侧胸交感神经切断术治疗原发性手汗症的疗效比较

［摘要］　目的　比较胸腔镜下T₃和T₄不同节段双侧胸交感神经切断术治疗原发性手汗症（PPH）的疗效。方法　回顾性收集2017年1月至2023年3月于首都医科大学宣武医院胸外科接受胸腔镜下胸交感神经切断术治疗的125例PPH患者的临床资料。根据切断胸交感神经节段的不同,将患者分为T₃组（60例）和T₄组（65例）。T₃组接受胸腔镜下T₃节段双侧胸交感神经切断术,T₄组接受胸腔镜下T₄节段双侧胸交感神经切断术。比较两组临床资料、术后不同时间点PPH复发率和代偿性出汗（CH）发生情况以及术后12个月时患者对手术的满意度。结果　两组年龄、性别、家族史、症状持续时间、PPH分级、手术时间、术后并发症和住院时间比较差异无统计学意义（P>0.05）,两组手术有效率均为100%。术后1个月、6个月、12个月时,两组PPH复发率比较差异无统计学意义（P>0.05）。术后1个月时,两组CH发生率和CH严重程度比较差异无统计学意义（P>0.05）。术后6个月、12个月时,T₃组CH发生率显著高于T₄组（P<0.05）,两组CH严重程度比较差异有统计学意义（P<0.05）。两组术后12个月时患者对手术的满意度比较差异无统计学意义（P>0.05）。结论　胸腔镜下T₃和T₄节段双侧胸交感神经切断术治疗PPH均显示出良好的效果。与T₄节段双侧胸交感神经切断术相比,T₃节段双侧胸交感神经切断术后6个月、12个月时的CH发生率较高。     

手汗症患者行胸交感神经干切断术后心率变异性的变化

目的观察手汗症患者行胸交感神经干切断手术前后心率变异性(HRV)的变化,评估胸交感神经干切断术对患者心脏自主神经系统功能的影响。方法选择本院接受胸交感神经干切断术(T3～T4或T2～T4)的手汗症患者20例,记录入院后第1天和术后24h12导联24h动态心电图,检测HRV的时域和频域指标并进行对比分析。结果与术前比较,胸交感神经干切断术后手汗症患者的全程记录中第5min正常RR间期平均值的标准差、相邻正常RR间期差值的均方根和相邻RR间期差值50ms的百分比升高(P均0.05),低频降低(P0.05),高频、低频/高频和连续24h内正常RR间期的标准差无差异。结论手汗症患者行胸交感神经干切断术后HRV增加,可能与术后交感神经系统的张力降低,而迷走神经紧张性相对增高,患者自主神经系统的平衡性得到改善有关。     

经脐超细胃镜下胸交感神经毁损术治疗女性手汗症25例临床观察

目的探讨经脐超细胃镜下胸交感神经毁损术治疗女性手汗症的安全性和临床应用价值。方法对25例女性手汗症患者行经脐超细胃镜下胸交感神经毁损术治疗,记录手术完成情况、手术时间、并发症发生情况,术后随访观察治疗效果。结果25例均顺利完成手术,术中患者生命体征平稳,手术时间58～113min,平均64min。无膈疝、脐疝发生,无霍纳氏综合征和血胸等严重并发症发生,仅3例术后并发少量气胸。出院后1周所有患者恢复学习和工作,脐部手术瘢痕小而隐匿,体表基本无可见切口。随访4～12个月,所有患者手部多汗症状完全消失,腋汗症状6例完全消失、4例明显改善、1例轻微好转。结论经脐超细胃镜下胸交感神经毁损术治疗手汗症安全有效,术后瘢痕小而隐匿,更加适合爱美的女性。     

Video-assisted sympathectomy for essential hyperhidrosis: effects on cardiopulmonary function

BACKGROUND: Essential hyperhidrosis is characterized by overactivity of the sympathetic fibers passing through the upper-dorsal ganglia (second and third thoracic ganglia [D2-D3]), and the treatment of choice is video-assisted thoracoscopy sympathectomy. Alterations in cardiopulmonary function after treatment have been reported. STUDY OBJECTIVE: To evaluate cardiopulmonary function impairment after sympathectomy in patients with essential hyperhidrosis. DESIGN AND SETTING: Prospective controlled trial at a pulmonary function unit of a university hospital. PATIENTS: Twenty patients (2 men and 18 women) with essential hyperhidrosis. MEASUREMENTS AND RESULTS: Pulmonary function tests, including spirometry and thoracic gas volume, bronchial challenge with methacholine, and maximal exercise, were performed before and 3 months after D2-D3 sympathectomy. Video-assisted sympathectomy was performed using a one-stage bilateral procedure with electrocoagulation of D2-D3 ganglia. Pulmonary function values (spirometrics and volumes) were not statistically different in the two groups. The maximal midexpiratory flow was the only variable that showed significant changes, from 101% (SD, 26%) to 92% (SD, 27%) [p < 0.05]. Ten patients had positive bronchial challenge test results that remained positive 3 months after surgery, and 2 patients whose challenge test results were negative before surgery became positive after sympathectomy. Significant reductions in maximal heart rate (HR) and oxygen and carbon dioxide uptakes were observed during the maximal exercise test. CONCLUSIONS: Video-assisted thoracoscopy is a safe treatment, and the observed modifications in cardiopulmonary function only suggest a minimal small airway alterations in the presence of positive bronchial hyperresponsiveness and mild sympathetic blockade in HR. The clinical importance of these findings is not significant.     

Heart rate variability as a potential diagnostic tool to predict compensatory hyperhidrosis after sympathectomy in patients with primary focal hyperhidrosis

BackgroundPrimary focal hyperhidrosis (PFH) is associated with autonomic nervous activity, and studies investigating this association in patients with PFH are very important. Heart rate variability (HRV) is a simple and noninvasive electrocardiographic test showing activity and balance in the autonomic nervous system, which consists of sympathetic and parasympathetic components. The aims of this study are to investigate associations between autonomic nervous activity and hyperhidrosis characteristics using HRV and to investigate the association between HRV findings and compensatory hyperhidrosis (CH) after sympathectomy.MethodsFrom March 2017 to March 2020, 105 subjects with PFH who underwent preoperative HRV tests and sympathectomy were analyzed. All subjects underwent bilateral thoracoscopic sympathectomy. T2 sympathectomy was conducted for craniofacial hyperhidrosis, and T3 sympathectomy was conducted for palmar hyperhidrosis. The following HRV parameters chosen to investigate the association between hyperhidrosis and autonomic nervous activity were measured by time and frequency domain spectral analysis: (I) time domain: standard deviation of normal-to-normal interval (SDNN) and square root of mean squared differences of successive normal-to-normal intervals (RMSSD), (II) frequency domain: total power (TP) of power spectral density, very low frequency (VLF), low frequency (LF), and high frequency (HF). HRV parameters were analyzed according to hyperhidrosis type (craniofacial vs. palmar type), sweat reduction, and CH after sympathectomy. In addition, the independent HRV parameters influencing CH after sympathectomy were investigated with multivariate analysis.ResultsCraniofacial hyperhidrosis was significantly more prevalent in the old age group (P<0.001). Sweat reduction after sympathectomy was significantly more prominent in palmar hyperhidrosis (P=0.037), and CH after sympathectomy was more prominent in craniofacial hyperhidrosis (P<0.001). Palmar type patients exhibited significantly larger SDNN, RMSSD, TP, LF, and HF than craniofacial type patients (all P<0.001). There were no significant differences in any HRV parameters according to sweat reduction after sympathectomy. Low-degree CH was associated with significantly larger SDNN, RMSSD, TP, LF, and HF than high-degree CH (P<0.001, P<0.001, P=0.002, P=0.001, and P<0.001, respectively). Multivariate analysis showed that HF and age group were associated with CH after sympathectomy (P=0.007 and P=0.010, respectively).ConclusionsThis study shows that HRV can provide useful insight into the pathophysiology of PFH and enhance preoperative risk stratification of CH. Large-scale, prospective studies are required to determine the predictive value of HRV in patients at risk for subsequent CH after sympathectomy.     

Thoracic endoscopic surgery for hyperhidrosis: comparison of different techniques

BACKGROUND: Hyperhidrosis is pathological perspiration in palmar, plantar or axillary surfaces. Video-assisted thoracic surgery (VATS) is currently the most commonly used therapy for hyperhidrosis. Blockage of sympathetic ganglia is achieved by segmental resection, transection and/or cauterization, and clipping of the chain. We aimed to compare the efficacy of these methods with respect to patient satisfaction, recurrence of symptoms and complications. METHODS: Eighty male patients with a mean age of 22.02 +/- 2.61 years undergoing bilateral thoracoscopic sympathectomy or sympathetic blockage to treat primary hyperhidrosis were included in this randomized study. The patients were divided into four groups depending on the technique used for sympathetic blockage; techniques included resection (n = 20), transection (n = 20), ablation (n = 20), and clipping (n = 20). RESULTS: The primary success rate for isolated palmar hyperhidrosis was 96.3 %; for palmar and axillary hydrosis it was 95.7 % and for palmar and face/scalp hyperhidrosis it was 66.7 %. No recurrence was observed. The overall success rate of the operation was 95 % and the differences between the four groups were not statistically significant. In the clipping group, the duration of the surgical procedure was significantly shorter than in the other groups. Complication rates were similar among the groups. The postoperative chest roentgenogram revealed pneumothorax in nine patients, but none of them required intervention. CONCLUSION: Thoracic endoscopic sympathetic blockage yields similar results irrespective of the surgical technique adopted.     

Thoracoscopic sympathetic block to predict compensatory hyperhidrosis in primary hyperhidrosis

BackgroundCompensatory hyperhidrosis is the main cause of patients’ dissatisfaction following sympathectomy for primary hyperhidrosis. Therefore, thoracoscopic sympathetic nerve block before sympathectomy can be used to predict compensatory hyperhidrosis after sympathectomy. The objective of this study is to review our recent experience with the nerve block procedure, describing efficacy, safety and validity.MethodsWe retrospectively reviewed the medical records of 107 patients who underwent thoracoscopic sympathetic nerve block with a local anesthetic for primary palmar and craniofacial hyperhidrosis using a 2-mm needlescope from March 2017 to November 2019. A week later, the patients were interviewed, and a decision made as to whether to proceed with sympathectomy. We analyzed the perioperative data of patients who underwent the predictive procedure either followed, or not followed, by sympathectomy.ResultsPrimary hyperhidrosis was relieved in all patients by the predictive procedure without severe complications. Compensatory hyperhidrosis happened to 32 patients (29.9%). Seventy-eight patients (72.9%) decided to undergo sympathectomy (group A) and 29 patients (27.1%) refused the sympathectomy (group B). Group B tended to have higher average body mass index (24.5 versus 23.2 kg/m², P=0.082) and compensatory hyperhidrosis rate after predictive procedure (37.9% versus 26.9%, P=0.269) compared to group A. The compensatory hyperhidrosis rate after sympathectomy in group A was 76.9%. The effective duration of sympathetic block was significantly longer in group A than in group B (33.5 versus 13.9 hours, P=0.001). The predictive procedure had 94.4% specificity and 33.3% sensitivity for prediction of compensatory hyperhidrosis.ConclusionsThoracoscopic sympathetic block may be safe and feasible as a procedure for predicting compensatory hyperhidrosis after sympathectomy, and beneficially, it allows the patients to experience the effect of sympathectomy on primary hyperhidrosis and occurrence of compensatory hyperhidrosis. However, a longer effective duration of sympathetic block is needed to help patients to decide whether to proceed with the surgery.