胸腔镜下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手汗症的可行性和安全性。方法应用单孔法胸腔镜下行T3和T4胸交感神经链切断术治疗手汗症20例。结果 20例均在胸腔镜下完成单孔手术,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,有效率迭100%。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。术后第2~3 d出现轻度代偿性出汗2例。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、切口隐蔽美观、疗效确切。     

单孔胸腔镜下胸交感神经链切断术治疗手-足汗症的临床分析

目的探讨单孔胸腔镜下胸交感神经链切断术治疗手-足汗症的临床效果。方法收集2009年1月-2011年1月在单孔胸腔镜下行胸交感神经链切断术治疗手-足汗症30例,手足多汗合并腋下多汗行T2～4切断术22例（A组）,未合并腋下多汗而行T2～3切断术8例（B组）,并对两组病例进行临床分析。结果 30例单孔胸腔镜下手术均获成功,术后手汗及腋下多汗均消失,足底无汗者24例,足底多汗减少者5例,足底多汗增多者1例。两组病例术后足底多汗改变差异无统计学意义（P〉0.05）。结论单孔胸腔镜下胸交感神经链切断术治疗手-足汗症疗效满意,创伤更小,恢复快,患者易接受。胸交感神经链切断术后部分患者足底多汗可减轻或消失。切断T2～4与切断T2～3对足汗症的影响无差异。     

两孔法胸腔镜下T2-T4交感神经链切断术治疗手汗症28例报告

目的评价两孔法胸腔镜下胸交感神经切断术（TES）治疗手汗症的疗效。方法采用TES治疗手汗症28例,均采用两侧胸交感神经链同一体位下一期切除。结果手术有效率100％,术后住院（3±2）d,所有病例术后双手立即干燥、红润。随访（30．5±20）个月。术后无再发手掌多汗和并发症。结论TES治疗手汗症简便有效、安全美观。     

胸腔镜下不同节段胸交感神经链切断术治疗手汗症的疗效及术后代偿性多汗发生率研究

目的 探讨胸腔镜下不同节段胸交感神经链切断术治疗手汗症的疗效及术后代偿性多汗的发生率.方法 将100例胸腔镜下行胸交感神经链切断术患者按治疗方法不同分为两组,A组46例切断T4,B组54例切断T3～4.比较两组患者疗效、代偿性多汗发生率及手术满意情况.结果 两组手术均较为顺利.两组总有效率比较差异无统计学意义（P＞0.05）.A组术后代偿性多汗发生率明显低于B组[4.3％（2/46）比20.4％ （11/54）],术后满意率高于B组[93.5％ （43/46）比79.6％（43/54）],差异均有统计学意义（P＜0.05）.结论 胸镜下T3～4或T4胸交感神经链切断术是非常有效且安全的治疗手汗症的方法,T4切断术后的代偿性多汗的发生率更低.     

单孔微创电视纵隔镜下胸交感神经链切断术治疗手汗症（附300例报告）

目的回顾性总结单孔电视纵隔镜（胸腔镜）下行胸交感神经链切断术治疗手汗症的临床经验。方法手术治疗手汗症患者300例,所有患者均单孔微创切口,切断T2-4。交感神经链。结果手术均获成功,术后患者手掌多汗症状消失,术毕掌温升高,无严重并发症发生,术后随访无复发。结论单孔纵隔镜（胸腔镜）下胸交感神经链切断术是安全、微创和有效的方法。     

俯卧位胸腔镜交感神经切断术治疗手汗症的临床体会

原发性手汗病是一种因交感神经兴奋异常升高致使患者手部极易出汗的病症[1],在天气热或紧张状态下,患者手汗明显增多,有时汗多如滴珠状,腋下及双足也会伴随多汗[2]。手汗症给患者日常生活、工作和学习带来了极大的困扰[3],临床上对手汗症的治疗研究日益受重视,对中重度手汗症患者,可采用半坐卧位或侧卧位胸腔镜交感神经切除术来治疗,有微创安全和疗效确切的     

电视胸腔镜下双侧交感神经切断术治疗手汗症效果好

山东大学齐鲁医院采用电视胸腔镜下双侧交感神经切断术治疗手汗症，取得良好效果。手汗症是较常见的一种原因不明的功能性局部异常多汗。有多汗症的人手掌大多时候都是湿漉漉的，而长期潮湿的手部常会造成脱皮，有碍观瞻，严重时手掌甚至会出现湿疹、皮肤炎性症状。     

针型胸腔镜交感神经干切除术治疗手足多汗症的手术室配合

目的 探讨120例针型胸腔镜T2～4交感神经干切除术治疗手足多汗症的手术室护理配合经验.方法 回顾120例手足多汗症的针型胸腔镜交感神经干切除术的手术室护理配合,全部病例于全麻下接受针型胸腔镜下T2～4交感神经干切断术,手术中监测手掌温度变化.手术前后采用生活质量指数评分（iQOL）进行疗效的评估.结果 所有手术顺利,术后手掌异常多汗等症状完全消失或明显好转,手术时间短,手术效果明显.结论 针型胸腔镜T2～4交感神经干切除术治疗手足多汗症安全、有效,手术室护理配合有助于手术顺利完成.     

胸腔镜下双侧胸交感神经切断术的手术配合

目的探讨胸腔镜下行双侧胸交感神经切断术的手术配合。方法本组59例病人全部采用全麻双腔气管内插管,取侧卧位,于腋中线第4～5肋间作切口放入10mm挫卡,再于腋前线第2～3肋间作切口放入5mm挫卡,用电钩切断T2、T3交感神经,在切断术侧交感神经干前后,测量同侧手掌皮肤温度。结果59例病人均在胸腔镜下顺利完成手术,术中无并发症发生,术后手汗症状立即消失,手部皮温上升了1.4～2.5℃,且双手干燥。59例患者术后采取门诊或电话随访,失访5例,54例随访16～30个月,平均18.0个月,术后手及腋窝多汗症状均消失,无一例复发。结论胸腔镜下行双侧胸交感神经切断术疗效确切,创伤小,术前充分的准备,术中熟练、默契的配合可使手术顺利完成。     

单孔胸腔镜下T_4交感神经链切断术治疗手汗症临床分析

目的探讨单孔胸腔镜下T4交感神经链切断术治疗手汗症的可行性及一些经验。方法自2008年8月1日至2012年5月1日,我科共诊治手汗症患者35例,应用单孔法行胸腔镜下双侧T4交感神经链切断术,观察手术前后双侧手掌皮肤温度,手术效果及并发症等情况。结果围手术期无严重并发症,所有患者手汗症状均完全缓解,双手皮肤温度明显升高。结论应用单孔胸腔镜下双侧T4交感神经链切断术治疗手汗症,疗效肯定,创伤小,值得推广。     

迷你腔镜交感神经电切断术治疗手汗症

目的探讨应用迷你腔镜和器械以及“二孔法”技术行交感神经切断治疗手汗症的可行性。方法于腋前线第4肋间和第2肋间分别做5 mm与3 mm微小切口,分别入3 mm或5mm迷你腔镜和2.5 mm勾状电极,行胸2交感神经链切断术治疗手汗症31例,不留置胸腔引流。结果手术全部成功,无术后出血、伤口感染等并发症,不用止痛剂,手术伤口少且细微。每侧平均手术时间(25±8)min。术后93.5%(29/31)患者手汗完全消失,1例双手汗减少,另1例一侧手汗完全消失,一侧减少。结论应用迷你腔镜器械和“二孔法”技术行胸交感神经切断治疗手汗症安全、可行、有效,而且美容效果显著。     

T3～4交感神经链切断术治疗手汗症的临床经验

目的 总结胸腔镜下T3～4交感神经链切断术治疗原发性手汗症的临床经验.方法 回顾性分析胸腔镜下T3～4交感神经链切断术治疗80例原发性手汗症患者的临床资料.结果 80例患者手术均获成功,术后手掌多汗症状立即消失,手术时间（42.5±15.7） min,住院时间（3.9±0.6）d.无霍纳综合征及死亡病例.62例患者随访6～24个月,发生轻度代偿性多汗26例,均无复发.结论 胸腔镜下T3～4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.     

Experiences with endoscopic thoracic sympathectomy

PATIENTS AND METHOD: Thoracic sympathectomy using thoracoscopy was performed in 38 cases on 35 patients from January 01. 1996, till December 31. 2000. In 3 cases bilateral sympathectomy was carried out. The youngest patient was 18, the oldest was 76 years old, the average age was 42 years. The indications for surgery were Raynaud syndrome, causalgia, post-traumatic sympathetic dystrophy, thoracic outlet syndrome combined with vasospastic syndrome, Buerger syndrome, obliteration of digital arteries, embolism and hyperhidrosis. This method was chosen if conservative therapy was unsuccessful. Laparoscopic instruments are particularly suitable for minimal invasive interventions. RESULTS: Authors describe their operative technique whereby the postoperative pain and also the duration of hospitalisation can be reduced, and the cosmetic result can be improved. In two cases conversion was the only choice due to pleural adhesions. Pneumothorax occurred in two cases, haemothorax in one case and transient intercostal neuralgy was seen in 3 cases. In four cases sympathetic activity returned during the follow up. Ceasing the sympathetic innervation dilates the arterioles of the skin, and the temperature of the skin increases. During follow-up the complaints of the patients improved significantly, the progression became slower and clear improvement was found with instrumental investigations. CONCLUSION: This method can be recommended to every institute where the conditions for traditional laparoscopic surgery are given and staff is experienced in thoracotomy.     

The Illness Intrusiveness Rating Scale: A measure of severity in individuals with hyperhidrosis

Objective: We estimated the reliability and validity of the Illness Intrusiveness Ratings Scale (IIRS) in hyperhidrosis, using an electronic mail form of administration. Methods: Recent contributors to an electronic mail discussion group on hyperhidrosis responded to the IIRS, questions about surgical history, items designed to assess severity, and demographic questions, on two occasions four weeks apart. A variety of hypotheses regarding the relationships between these variables were constructed a priori. Results: Sixty-eight people replied on two occasions. Internal consistency was high (Cronbach's 0.88), as was test–retest reliability ( 0.89). The total IIRS score correlated with a global severity question (0.61; p<0.001). Total IIRS score was lower in participants who had previously had surgery for hyperhidrosis, compared with those who had not (47 vs. 36; p=0.02), and changed dramatically in the direction of diminished severity in four patients who underwent surgery during the course of the study (54 vs. 17; p=0.01). Weak-to-moderate correlations were observed between total score and use of topical preparations, use of medications, number of clothing changes during a day, and limitations in choice of wardrobe. Conclusions: The IIRS is both reliable and valid in the assessment of patients with hyperhidrosis. A novel form of administration does not appear to affect its properties.     

Effectiveness and safety of endoscopic thoracic sympathectomy for excessive sweating and facial blushing: a systematic review

OBJECTIVES: Despite controversies, endoscopic thoracic sympathectomy (ETS) has been used as a treatment for excessive sweating of hands and face and for facial blushing. This study aims to evaluate the effectiveness of ETS for the current indications in a systematic review. METHODS: Controlled clinical trials and cohort studies with more than 100 patients were included. Abstracts were searched from MEDLINE and CCTR from 1966 to June 2004. Two reviewers extracted the data and assessed study quality. Data on effectiveness and safety were synthesized qualitatively. RESULTS: We did not find any controlled clinical trials. Fifteen prospective studies were included. The internal and external quality of these studies were poor overall. Follow-up was commonly less than 2 years, during which time excessive sweating and facial blushing seemed to decrease among most patients. Immediate complications related to thoracoscopy occurred in up to 10 percent of patients. Compensatory sweating below breast level was reported in up to 90 percent of the patients. Other common side effects included dryness of face and hands, gustatory sweating, and neuralgic pain. Several other less common side effects were reported. CONCLUSIONS: The evidence of the effectiveness of ETS is weak due to a lack of randomized trials. The intervention leads to severe immediate complications in some of the patients, and to persistent side-effects for many of the patients.     

胸腔镜辅助改良Nuss手术治疗49例小儿漏斗胸临床分析

目的 总结胸腔镜辅助改良Nuss手术矫治小儿漏斗胸的治疗经验.方法 采用胸腔镜辅助改良Nuss手术矫治49例漏斗胸患者,年龄3～18岁,平均年龄(8.9±4.6)岁.36例畸形为对称型,13例为非对称型.结果 49例患者手术过程顺利,除1例应用2根支撑钢板外,其余48例均只用1根支撑钢板.术中未发生心脏穿通伤等重大并发症,1例早期并发气胸,平均出血量少于10 ml.术后住院时间6～8 d,所有患者均未输血,胸廓畸形矫正满意.矫形效果43例为优,6例为良.全部患者随访时间0.5～23.0个月,钢板无移位,1例术后间歇疼痛2个月,1例术后23个月取出钢板矫形保持优良.结论 改良Nuss手术操作简捷,创伤小,胸廓塑形满意.胸腔镜辅助监视可提高手术的安全性.