胸腔镜下交感神经链切断术治疗原发性手汗症疗效观察

目的观察比较胸腔镜下交感神经链切断术于T2及T3水平治疗原发性手汗症的治疗效果。方法应用电视胸腔镜交感神经链切断术治疗手汗症患者42例,其中25例行T2~4节段交感神经干切断术,17例行T3~4节段交感神经干切断术。术后1、6、12及24个月门诊及电话随访,观察患者手汗症复发情况及术后代偿性多汗的情况。结果全组术后手掌多汗症状立即消失,双手干燥温暖;术后3~6天出院,平均住院时间（4.1±0.8）天;无手术死亡和切口感染,术后随访期间无Horner s综合征出现,无复发病例;两种手术方式的代偿性多汗的发生率在各个观察期无明显差异（P〉0.05）;代偿性多汗严重程度在术后1个月随访时两组差异不明显,6个月及12个月时T2~4节段交感神经干切断术的代偿性多汗明显较T3~4节段交感神经干切断术严重（P〈0.05）。结论胸腔镜下交感神经干切断术治疗手汗症,术后无复发,T2切除节段及T3节段术后代偿性多汗情况无差异,但T2节段代偿性多汗较T3节段明显严重。

Observation on treatment of primary palmar hyperhidrosis by thoracoscopic sympathectomy

Objective To observe and compare the treatment of primary palmar hyperhidrosis by thoracoscopic sympathectomy at T2 and T3 level.Methods From March 2008 to April 2010,42 cases of palmar hyperhidrosis underwent thoracoscopic sympathectomy,in which 25 cases underwent sympathectomy in T2～4 segments and 17 cases in T3～4 segments.Out-patient and telephone follow-up were carried out after 1,6,12 and 24 months to observe the recurrence and postoperative compensatory hyperhidrosis of the patients.Results Symptoms of palmar hyperhidrosis disappeared immediately after surgery,without death and infection of incisional wound.All the patients were discharged 3 to 6 days after surgery,with the average length of stay for 4.1±0.8 days.During the postoperative follow-up,there was no Horner＇s syndrome and recurrence.No significant difference was observed in the incidence of compensatory hyperhidrosis in each observation period（P 0.05）.There was no significant difference between the two groups in the severity of compensatory hyperhidrosis during follow-up 1 month after surgery.At the 6th and 12th month after surgery,compensatory hyperhidrosis after sympathectomy in T2 ~ 4 segments is significantly more serious than that after sympathectomy in T3 ~ 4 segments（P 0.05）.Conclusion Thoracoscopic sympathectomy is a good treatment for palmar hyperhidrosis with no recurrence after surgery.Compensatory hyperhidrosis after sympathectomy in T2 segment is obviously more serious than that after sympathectomy in T3 segment.The difference is not significant（P 0.05）.