两种不同入路单孔胸腔镜T3交感神经链切断术的应用对比研究

目的对比两种不同入路(经剑突下入路与经两侧腋下入路)单孔胸腔镜双侧T3交感神经链切断术治疗原发性手汗症的可行性及安全性。方法从2011年10月-2015年9月,该科共完成单孔胸腔镜双侧T3交感神经链切断术治疗手汗症47例,其中经剑突下单孔胸腔镜行双侧T3交感神经链切断术11例(A组),经双侧腋下单孔胸腔镜行T3交感神经链切断术36例(B组),通过观察术后疼痛、术后并发症、症状好转程度、远期有无复发及代偿性多汗等指标,对比两种不同入路单孔胸腔镜手术的疗效及安全性。结果两组患者均顺利完成手术,A组平均手术时间为(74.00±12.00)min,术后平均住院时间为(2.00±0.70)d,术后1周使用镇痛药物氨酚双氢可待因平均剂量(26.30±9.20)mg,B组平均手术时间为(56.00±16.00)min,术后平均住院时间为(2.30±1.00)d,术后1周使用镇痛药物氨酚双氢可待因平均剂量(48.30±12.00)mg。近期均无血胸、气胸、Hornor综合征等并发症,随访两组均无复发,两组患者对比围手术期数据,经剑突下入路手术平均时间较经双侧腋下入路手术长,术后各项并发症及治疗效果差异无统计学意义,但术后疼痛程度明显减轻。结论与传统的经双侧腋下切口单孔胸腔镜T3胸交感神经链切断术相比,经剑突下单孔胸腔镜治疗手汗症具有更微创的优势,减轻了术后出现的肋间神经疼痛症状,疗效及安全性确切,值得进一步推广。

Comparison of two different approaches of uniport video-assisted thoracoscopic in T3 sympathectomy

Objective To compare the efficacy of two different approaches (xiphoid incision and bilateral chest wall incision) of uniport thoracoscopic bilateral T3 sympathectomy in treatment of primary palmar hyperhidrosis. Methods From October 2011 to September 2015, 47 patients underwent uniport thoracoscopic bilateral T3 sympathectomy for primary palmar hyperhidrosis. 11 cases of them underwent xiphoid incision (group A), 36 cases underwent bilateral axillary incision (group B), then observe the postoperative pain, postoperative complications and the degree of symptoms improvement, recurrence and compensatory hyperhidrosis, compare the efficacy and safety between the two groups. Results Patients in the two groups were successfully completed surgery, average operation time of group A was (74.00 ± 12.00) min, average hospitalization time was (2.00 ± 0.70) d, average does of analgesic drugs in postoperative 1 week (Paracetamol and dihydrocodeine) was (26.30 ± 9.20) mg; average operation time in group B was (56.00 ± 16.00) min, average hospitalization time was (2.30 ± 1.00) d, average does of analgesic drugs in postoperative 1 week (Paracetamol and dihydrocodeine) was (26.30 ± 9.20) mg. No recent complications such as hemothorax, pneumothorax, Hornor syndrome was observed. No recurrence during the follow-up period was observed. While the average operation time of xiphoid incision group is longer than bilateral axillary incision group, there was no significant difference in the various complications and treatment effect, but xiphoid incision group significantly relieve postoperative pain. Conclusion Compared with the traditional uniport bilateral axillary incision thoracoscope T3 sympathectomy, the xiphoid incision uniport thoracoscope T3 sympathectomy treat primary palmar hyperhidrosis has more minimally invasive advantages and reduced postoperative pain which is valid and safety, and worthy of further promotion.