不同节段胸交感神经干切断术治疗手汗症疗效及术后代偿性多汗的比较（附1040例报告）

目的：比较胸腔镜下不同节段胸交感神经干切断术治疗手汗症的疗效和术后代偿性多汗的差异。方法本院自1995年7月至2011年12月，收治的原发性手汗症患者共1040例。依据切断胸交感神经节段的不同分为两组比较分析。A组（不保留T2神经节段）503例， B组（保留T2神经节段）537例。对上述两组病例进行随访观察，评定与比较两组之间的疗效以及代偿性多汗的发生情况。结果1040例患者随访到834例，随访率80.2%。到访两组手术成功率均为100%，术中、术后无严重并发症发生，术后12个月内两组代偿性多汗总体发生率37.8%（315/834）。两组代偿性多汗和重度代偿性多汗发生率的差异均有统计学意义（P＜0.01或＜0.05）。结论与经典的A组（不保留T2神经节段）胸交感神经干切断术相比，B组（保留T2神经节段）T3或T4胸交感神经干＋旁路切断术式疗效确切，且能明显减少代偿性多汗的发生率，是一种较为合理的术式。

Analysis of the efficacy of video-assisted thoracoscopic sympathectomy and the differences of compensatory hyperhidrosis after sympathec-tomy in the treatment of palmar hyperhidrosis by different operative methods and/or exscinding positions

Objective To analyze the efficacy of video-assisted thoracoscopic sympathectomy and the differences of compensatory hyper-hidrosis after sympathectomy in the treatment of palmar hyperhidrosis by different operative methods. Methods 1040 patients with palmar hyper-hidrosis being undergone video-assisted thoracoscopic bilateral sympathectomy were retrospectively studied during the period of July 1995 and De-cember 2011. The patients were divided into two groups for Group A （T2 not remained）and Group B （T2 remained） by different operative methods. Results All the cases were successfully performed for video assisted thoracoscopic bilateral sympathectomy without severe morbidity and mortality. 834 cases were followed up from 1040 patients. The incidence of compensatory hyperhidrosis of two groups were 37.8%（315/834）.There were signifi-cant differences for compensatory hyperhidrosis and serious compensatory hyperhidrosis between group A and group B （ P〈0.01 or P〈0.05）. Con-clusion Video-assisted thoracoscopic bilateral sympathecotomy is an effective operative method to cure hyperhidrosis. By comparing with the tradi-tional video-assisted thoracoscopic T2 sympathectomy in Group A, the T3 or T4 sympathecotomy plus resection procedure of bypass fiber in Group B is reasonable operative method to cure hyperhidrosis with the best curative effect and the lowest incidence of compensatory hyperhidrosis.