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。     

应用胸腔镜微创技术行胸交感神经切断术治疗手汗症

目的探讨应用胸腔镜微创外科技术治疗手汗症的可行性及临床效果。方法回顾分析1997年3月至2004年7月应用胸腔镜微创手术器械施行胸部交感神经切断术治疗手掌多汗症16例临床资料，总结其方法及临床应用价值。结果手术全部成功，术后双手立即干燥、红润。手术时间平均25min，住院平均3．8d，术后无并发症发生。术后随访1个月～5年，偶见有躯干代偿性多汗，但症状轻微，患者无心理负担。结论胸腔镜微创外科技术胸交感神经切除术能准确有效处理胸交感神经链，是治疗手汗症有效方法。     

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。     

胸腔镜下T3胸交感神经切断术治疗手汗症62例临床分析

目的探讨胸腔镜下T3胸交感神经切断术治疗手汗症的疗效。方法 2008年7月～2011年3月对62例手汗症行胸腔镜下经操作孔电凝钩切断T3胸交感神经及可能存在的交通支。结果 62例手术均获成功,手术时间(双侧)19～36 min,平均24.3 min。住院3～6 d,平均4.5 d。术后出现胸腔积液9例,4例行胸腔穿刺抽液,5例经保守治疗治愈。56例术后随访3～12个月,平均7.2月,2例复发轻度手汗,3例出现轻度代偿性出汗。结论胸腔镜下T3胸交感神经切断术治疗手汗症疗效确切,不易复发,术后代偿性多汗发生率低,安全性高。     

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。     

胸腔镜下T4交感神经链及其侧支切断术治疗手汗症61例

目的 总结胸腔镜下T4交感神经链及其侧支切断术治疗手汗症的疗效. 方法 回顾性分析本院2011年11月至2013年1月,对61例手汗症患者行胸腔镜下T4交感神经链及其侧支切断术. 结果 全部手术顺利,61例术后手掌多汗症状均消失,术前伴足底多汗39例、腋汗25例,术后症状消失或明显减轻分别为29例(74.3％)和22例(88％).术后3例(4.5％)出现轻度代偿性出汗,无1例中重度代偿性出汗病例发生. 结论 胸腔镜下T4交感神经链及其侧支切断术治疗手汗症,是安全、有效的治疗方法.     

胸腔镜单孔隐蔽切口治疗手汗症30例

目的探讨胸腔镜单孔隐蔽切口手术治疗手汗症的可行性和安全性。方法回顾性分析2012年1月～2013年2月我院30例胸腔镜单孔隐蔽切口手术治疗手汗症的临床资料。对男性患者采取经乳晕弧形切口,女性患者采取第3肋间乳腺外缘腋下小切口,行R3（riblevels）胸腔镜交感神经链切断术（endoscopic thoracic sympathectomy,ETS）。结果均顺利完成胸腔镜手术。随访时间1～14个月,平均8．2月,其中7例〉12个月。术后手汗均消失,4例（13．3％）轻度代偿性多汗,无需进一步治疗,术后2个月好转。无霍纳综合征。术后切口隐蔽,瘢痕不明显,患者满意。结论胸腔镜下胸交感神经链切断术是目前治疗手汗症的安全、微创、有效的方法,隐蔽切口更能进一步满足患者的美容要求,增加患者对手术的满意度。     

胸腔镜交感神经链切断术治疗手汗症

原发性手汗症主要症状是以手掌多汗为主．汗多时呈串珠样滴落,与情绪、季节有关,严重影响学习、工作与生活。传统的胸腔镜下胸交感神经T2-4切除术（TES）已经成为一种比较普及的治疗方法,但手术复杂,并发症多。2003年4月至2009年1月．笔者采纳有所简化的手术方法实施治疗手汗症患者117例。     

自制穿刺式电刀在微型胸腔镜治疗手汗症中的应用

目的探讨微型胸腔镜下用穿刺式电刀行胸交感神经切断术治疗手汗症的可行性。方法 2005年3月～2010年2月,用克氏针加绝缘胶套自制成穿刺式电刀,在2 mm胸腔镜监视下,用穿刺式电刀在第4肋间腋中线处穿刺进入胸腔,行双侧T3、T4交感神经切断术治疗37例手汗症。结果 37例手术均获成功,手术时间27～40 min,平均32 min。术后3～5 d出院,平均4.5 d。术后5例少量气胸,其中1例须胸腔穿刺。随访6～24个月,平均18个月,无复发,双手干燥1例,躯干代偿性多汗4例。结论微型胸腔镜下用穿刺式电刀行胸交感神经切断术治疗手汗症可行,疗效确切,创伤小,安全性高。     

Phenylketonuria (PKU) in the RSA

Eighteen patients with hyperhidrosis affecting different anatomical areas were treated with a variety of surgical methods. Bilateral axillary gland excision is an appropriate and cosmetically acceptable method of treating axillary hyperhidrosis (11 patients). Bilateral supraclavicular cervical sympathectomy was performed for excessive sweating of the hands (7 patients). Bilateral lumbar sympathectomy was necessary in only 3 patients with excessive sweating of the feet. When perineal hyperhidrosis is present, the first lumbar ganglia must be excised. Transaxillary, transpleural sympathectomy, removing the first to fourth thoracic ganglia, is successful in treating failures of sweat gland excision or troublesome sweating of hands and axillae.     

Skin wrinkling for the assessment of sympathetic function in the limbs

BACKGROUND: Wrinkling of the skin of the palm and sole is considered to be dependent on the presence of intact sympathetic nervous activity. Loss of sympathetic integrity could be simply and usefully assessed by the absence of wrinkling. To test this hypothesis, the skin wrinkle test was compared with the starch-iodine sweat test and sympathetic skin response (SSR) in patients with abnormal sympathetic function. METHODS: The three tests were carried out in 34 patients (68 limbs) undergoing temporary or permanent disruption of the sympathetic chain to upper or lower limbs. Included in this group were six diabetics undergoing chemical or surgical sympathectomy, lumbar epidural infusions following vascular surgery, and patients for whom sympathectomy was being considered. Sensitivity and specificity analysis and predictive values of the wrinkling response and the starch-iodine test were related to the SSR as the standard. RESULTS: The wrinkle test showed a sensitivity of 97% and specificity of 95%, and bore good correlation to the SSR. The starch-iodine test showed sensitivity of 55% and specificity of 93%. A hypothesis for the mechanism of wrinkling based on the observations of the present study is proposed. CONCLUSION: The wrinkle test is a reliable test of sympathetic function, is inexpensive and is easy to perform at the bedside. The sweat gland myo-epithelial cells and absence of sebum could play an important role in the wrinkling response. It can be used to select patients who will benefit from sympathectomy, and can adequately evaluate sympathetic blockade.     

Treatment of Axillary Hyperhidrosis:

OBJECTIVE: To evaluate and permanently improve axillary hyperhidrosis. BACKGROUND: Excessive sweating of the axillae is a common problem for which patients frequently seek dermatologic advice and therapy. Many treatments, including aluminum chloride, topical and systemic anticholinergic agents, tranquilizers, iontophoresis, direct surgical excision, botulinum toxin injection, and thoracic sympathectomy, have been employed to control this problem. All have drawbacks of one sort or another. METHODS: The starch-iodine technique for delineation of preoperative and postoperative axillary sweating is described in detail. A method of sweat gland removal utilizing tumescent liposuction is discussed. RESULTS AND CONCLUSION: The combination of the starch-iodine technique and tumescent liposuction is safe and effective for therapy of axillary hyperhidrosis.     

人胚胎期表皮干细胞与汗腺发生过程关系的研究

目的　观察表皮干细胞与胚胎期汗腺发生过程的关系 ,为诱导表皮干细胞向汗腺细胞定向分化奠定基础。　方法　分别取 13～ 3 1周胎龄人胎儿背部全层皮肤 ,采用常规组织学、免疫组织化学染色法 (SP法 ) ,动态观察汗腺原基细胞、汗腺胚芽细胞及汗腺细胞中 β1整合素与细胞角蛋白 19(K19)的表达特征。以细胞角蛋白 8(K8)免疫组化染色阳性为汗腺发生及成熟的鉴定标准。　结果　组织学观察显示 ,胎龄 16周的皮肤 ,初级表皮嵴基底层细胞呈灶性聚集 ,形成小丘状 ,继而形成圆柱状细胞索向深层切入 ;至胎龄第 2 4周时 ,细胞索末端部分形成蟠状 ,表现为成熟汗腺特征。不仅汗腺原基细胞、汗腺胚芽细胞表达 β1整合素与K19,成熟的汗腺细胞亦有表达 ,并持续存在于汗腺发生全过程。K8始于 14～ 16周 ,在汗腺胚芽细胞内表达并持续存在。　结论　汗腺于胎龄 14～ 16周开始发生 ,至第 2 4周基本成熟。胚胎期汗腺发生过程中 ,表皮干细胞是汗腺发生的源泉     

The interaction between epidermal growth factor (EGF) and matrix metalloproteinase induces the development of sweat glands in human fetal skin

Objective:The development of sweat glands is a very complicated biological process involving many factors. In this study, we explore the inter-relationship between epidermal growth factor (EGF),matrix metalloproteinases (MMP-2,MMP-7) and development of sweat glands in human embryos. Furthermore, we hope to elucidate the mechanism(s) underlying the induction of epidermal stem cells into sweat gland cells. Methods:Skin biospies of human embryos obtained from spontaneous abortions at different gestational ages from 11 to 31 weeks were used in this study. The dynamical expression of EGF, MMP-2, MMP-7 and keratin-7 (K7) in developing sweat gland cells or extracellular stroma surrounding the sweat gland cells were examined with S-P immunohistochemical methods.The localization of the cellular sources of MMP-2 and MMP 7 was examined with in situ hybridization. Results:At 14-20 wk of gestation, a gradual increase in EGF immunoreactivity was observed not only in developing sweat gland buds but also in extracellular stroma surrounding the buds,and the expression intensity peaked at 20-22 wk of gesta- tional age. All mRNA-positive buds or cells in developing sweat glands contained corresponding immunoreactive proteins. Positive immunostaining for K7 appeared in early sweat gland buds at 14-16wk of gestation, and from then on, K7 was concentrated in developing sweat gland cords or cells. Conclusions: The morphogenesis of sweat gland in human fetal skin begins at 14-16wk of gestational age, and essentially completes by 24wk. There is a close relationship among EGF,extracellular matrix remodeling and morphogenesis of sweat glands, and EGF is one of the inducers in the development and maturity of sweat gland buds or cells.     

The interaction between epidermal growth factor and matrix metalloproteinases induces the development of sweat glands in human fetal skin

BACKGROUND: The development of sweat glands is a very complicated biological process involving many factors. In this study, we explore the interrelationship among epidermal growth factor (EGF), matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 7 (MMP-7), and the development of sweat glands in human embryos. Furthermore, we hope to elucidate the mechanism(s) underlying the induction of epidermal stem cells into sweat gland cells. MATERIALS AND METHODS: Skin biopsies of human embryos obtained from spontaneous abortions at different gestational ages from 11 to 31 weeks were used in this study. The dynamic expression of EGF, MMP-2, MMP-7, and keratin-7 (K7) in developing sweat gland cells or extracellular stroma surrounding the sweat gland cells was examined with SP immunohistochemical methods. The localization of the cellular sources of MMP-2 and MMP-7 was examined with in situ hybridization. RESULTS: At 14-20 weeks of gestation, a gradual increase in EGF immunoreactivity was observed not only in developing sweat gland buds but also in extracellular stroma surrounding the buds, and the expression intensity of EGF peaked at 20-22 weeks of gestational age. All mRNA-positive buds or cells in developing sweat glands contained corresponding immunoreactive proteins. Positive immunostaining for K7 appeared in early sweat gland buds at 14-16 weeks of gestation, and from then on, the positive signal of K7 was concentrated in developing sweat gland cords or cells. CONCLUSIONS: The morphogenesis of sweat glands in human fetal skin begins at 14-16 weeks of gestational age, and is essentially complete by 24 weeks. There is a close relationship among EGF, extracellular matrix remodeling, and morphogenesis of the sweat glands. EGF is one of the inducers in the development and maturity of sweat gland buds or cells.     

Sweat gland carcinoma

Sweat gland carcinoma is a rare malignant tumor of the skin adnexa that can occur in a variety of locations. It is a slow-growing tumor that metastasizes early and often. The rarity of this tumor has led to a relative lack of adequate evidence with regard to treating this entity. Recent advances in immunohistochemical staining have better defined this tumor and have aided in diagnosing its subtypes though histologic grade and presence of regional lymph nodes at the time of diagnosis. These are the best indicators for prognosis and management currently available. Indications for sentinel node biopsy are currently not well defined. Because of the poor prognosis of high-grade sweat gland carcinoma, clinicians should be aware of this entity and be prepared to treat aggressively. Management of sweat gland carcinoma is difficult because extensive study into both surgical and nonsurgical treatment has not been done. We present a case of sweat gland carcinoma of the lower extremity and a review of the clinicopathologic literature of these rare neoplasms, including diagnosis and surgical management.     

人胎儿皮肤皮脂腺细胞和外泌汗腺细胞的分离培养及鉴定

目的建立人胎儿皮肤皮脂腺、外泌汗腺细胞的体外分离培养与鉴定方法。方法通过分离人胎儿皮肤皮脂腺腺体和外泌汗腺腺管,以DMEM/F12(1∶1)为基础培养基,分别添加不同浓度的胎牛血清、表皮生长因子、L-谷氨酰胺、氢化可的松、霍乱毒素、青霉素、链霉素、重组人表皮生长因子、三碘甲状腺氨酸、胰岛素、转铁蛋白、亚硒酸钠作为皮脂腺细胞培养基及外泌汗腺细胞培养基,置入37℃、体积分数5%CO2孵箱中进行原代及传代培养。倒置相差显微镜下观察人胎儿皮肤皮脂腺、外泌汗腺细胞的形态及变化,并进行细胞克隆形成率测定。采用油红染色和细胞角蛋白(CK)4.62、上皮膜抗原(EMA)免疫组织化学染色对传代培养的皮脂腺、外泌汗腺细胞进行鉴定。结果分离的人胎儿皮脂腺腺体和外泌汗腺腺管可以在体外贴壁生长繁殖;其皮脂腺细胞的克隆形成率为2.7%,明显低于人胎儿角质形成细胞(8.0%,P<0.01).人外泌汗腺细胞的克隆形成率为7.3%,与人胎儿角质形成细胞(7.7%)比较差异无统计学意义(P>0·05).油红染色显示,皮脂腺细胞含有少量脂质小滴,CK4.62、EMA免疫组织化学染色均为阳性;外泌汗腺细胞CK7、CK19免疫组织化学染色均为阳性。结论用酶消化法和显微分离法可体外分离人胎儿皮肤皮脂腺、外泌汗腺细胞,两者均具备上皮细胞的标志和生物学特点,但皮脂腺细胞增殖速度较为缓慢。     

Surgical management of primary hyperhidrosis

Primary hyperhidrosis, although lacking a precise definition and of unknown aetiology, disrupts professional and social life and may lead to emotional problems. A variety of treatment methods are used to control or reduce the profuse sweating which involves mainly the palms, soles and axillae. The simplest method, the application of topical agents, is usually attempted first for axillary and plantar sweating. Iontophoresis may provide relief especially in patients with plantar or palmar involvement. In severe cases operative intervention is necessary. Excision of sweat glands is successful in patients with axillary hyperhidrosis but the role of suction-assisted removal of axillary sweat glands remains to be determined. Sympathectomy remains the standard by which other treatments must be judged. For upper thoracic sympathectomy a variety of surgical approaches are used with satisfactory relief of hyperhidrosis. Complications related to the surgical approach, such as Horner's syndrome, brachial plexus injuries, pneumothorax and painful scars may occur, while following sympathectomy compensatory hyperhidrosis is usual and hyperhidrosis may recur. Plantar hyperhidrosis which may be exacerbated or ameliorated by upper thoracic sympathectomy and which fails to respond to non-operative intervention is relieved by lumbar sympathectomy.     

分离培养汗腺导管部细胞的新方法

目的 探讨建立汗腺导管部细胞分离的新技术.方法 成人仞厚皮片和薄中厚皮片标本(n=10)剪碎后用Ⅱ型胶原酶消化12 h,吸取并转移汗腺导管到培养皿中贴壁培养.应用流式细胞仪、免疫组织化学染色和逆转录-聚合酶链式反应(RT-PCR)以及蛋白印迹(Western Blot)分析检测培养细胞的汗腺特异标志CEA、CK8、CK18、CK19抗原表达,并用膜片钳技术检测培养细胞膜上阿米洛利(amiloride)敏感Na~+离子通道,用t检验比较分析两组间实验数据.结果 汗腺导管贴壁48 h后,围绕汗腺导管出现单层扁平的上皮细胞,生长2～4周融合成片.流式细胞学检查示原代培养汗腺导管细胞与原代培养汗腺细胞在癌胚抗原(CEA)阳性率[(90.26±1.12)%vs.(89.70±1.43)%]和细胞角蛋白8(CK8)阳性率[(94.41±1.84)%vs.(93.65±1.63)%]上,差异无统计学意义(P>0.05).形态学染色汗腺导管细胞抗CEA、CK8、CK18、CK19染色均为阳性.RT-PCR表明原代培养汗腺导管细胞表达CEA、CK8、CK18、CK19基因,Western Blot清晰显示CEA条带,CK8、CK18、CK19蛋白条带.膜片钳检测表明原代培养汗腺导管细胞膜上存在amiloride敏感Na~+离子通道.无血清表皮细胞EpiLife培养基在汗腺导管细胞生长过程中抑制成纤维细胞生长.结论 从仞厚皮片和中厚皮片分离培养汗腺导管部细胞的方法较传统的分离方法具有简便快速的优点,EpiLife培养基可抑制培养过程中成纤维细胞的生长,可以在体外建立最佳汗腺导管细胞模型.