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.

Bilateral sympathectomy via thoracoscope for treatment of idiopathic hyperhidrosis

Objective To summarize our experience in endoscopic thoracic sympathectomy (ETS) in treating palmar hyperhidrosis (PH) and investigate the feasibility of ETS for treating PH by hand surgeons.Methods From 2006 to 2010,23 patients who had palmar hyperhidrosis were treated by a single surgeon via endoscopic thoracic sympathectomy.The T2 to T3 thoracic sympathetic chain was interrupted by electrocautery.The patients were followed up once every three months.Treatment that resulted in palm skin temperature increase of 1℃ or more and dry and warm palm skin was considered effective.Treatment that resulted in palm skin temperature increase less then 1℃ and wet palm skin was considered ineffective.Results All patients had immediate cessation of palmar hyperhidrosis.Mild compensatory hyperhidrosis on the back or sole was noted in 4 patients.No moderate to severe compensatory hyperhidrosis or other complications were observed.Postoperative follow-up ranged from 3 moths to 3 years,with an average of 18 months.There was no recurrence.The effective rate was 100％.Conclusion Endoscopic thoracic sympathectomy is a safe and effective way to treat palmar hyperhidrosis and is a procedure that can be mastered by hand surgeons without a steep leaming curve.