电视胸腔镜手术治疗手汗症不同术式的选择

目的 回顾分析胸腔镜下不同术式治疗手汗症的远期疗效及术后代偿性多汗情况,供选择术式做参考.方法 对浙江省人民医院心胸外科自1995年7月至2008年8月接受电视胸腔镜双侧胸交感神经链部分切除术治疗手汗症的643例患者进行随访并分析,其中随访到498例(77.4%),按手术方式不同分为4组:A组:T2-4交感神经链切除82例;B组:T2交感神经链切断135例;C组:T2交感神经链夹闭41例;D组:T3-4交感神经链切除+旁路纤维(Kuntz纤维)切除240例.结果 4组患者均无手术死亡,手掌多汗症状治疗有效率达100%.4组代偿性多汗总体发生率分别为54.9%、48.1%、48.8%、28.8%,重度代偿性多汗发生率分别为9.8%、10.4%、9.8%、2.9%,D组与其他3组相比,无论是代偿性多汗总体发生率还是重度代偿性多汗发生率,差异均有统计学意义,D组明显低于其他3组,A、B、C 3组之间比较差异均无统计学意义.A、B、C、D 4组术后手汗症复发率分别为1.2%、2.2%、7.3%、0.8%,发现D组的手汗症术后复发率明显较C组低,差异有统计学意义(x2=8.423,P=0.004),其余互相之间的比较差异均无统计学意义.结论 胸腔镜下T3-4双侧交感神经链及旁路纤维切除术,是治疗手汗症、减少术后代偿性多汗并发症的良好选择.

The choice of thoracoscopic sympathecotomy in the treatment of palmar hyperhidrosis among different procedures

Objective Retrospective analyze the long-term efficacy and compensatory sweating of thoracoscopic sympathicotomy in the treatment of palmar hyperhidrosis by different operative methods in order to search after a better operative method. Methods Retrospective study of 643 cases (498 cases available)palmar hyperhidrosis who accepted video-assisted thoracoscopic bilateral sympathecotomy during from 1995 to Aug 2008. The patients were divided into four groups by different operative methods. ( 1 ) Group A( n = 82 ):Thoracoscopic T2-4 sympathecotomy was performed. (2) Group B (n = 135 ) :Thoracoscopic T2 sympathetomy was performed. ( 3 ) Group C ( n = 41 ): Thoracoscopic T2 sympathetic nerve clipped. (4) Group D ( n = 240 ):Thoracoscopic T3-4 level sympathecotomy plus bypass fiber ( Kuntz fiber) resection on same level was performed. Results All procedures were successfully performed under thoracoscope without severe morbidity and mortality. The curative rate of palmar hyperhidrosis was 100. 00%. The incidence of compensatory sweating were 54. 9% ( group A) ,48. 1% ( group B) ,48.8% ( group C) and 28. 8% ( group D) respectively with significantly decrease in group D contrast to other three groups. The incidence of high-grade compensatory sweating which have important infleuces on daily life were 9. 8% (group A), 10. 4% (group B) ,9.8% (group C) and 2.9% (group D) respectively with significantly decrease in group D. Other pairings have nonsignificance. The relapse rate were 1.2% ( group A ), 2. 2% ( group B), 7. 3% ( group C )and 0. 8% (group D). Only when group D contrasted to group C has significantly decrease in the relapserate (x2 = 8. 423, P = 0. 004 ). Other pairings have nonsignificance. Conclusion The procedure of T3-4 sympathicotomy plus bypass fiber resection is reasonable operative method to cure hyperhidrosis with the better curative effect and lowest incidence of compensatory hyperhidrosis.