胸交感神经切断术治疗原发性手汗症2206例:10年结果和分析

发布时间：2018-02-12 08:07

  本文关键词： 手汗症 胸腔镜下胸交感神经切断术 转移性多汗　出处：《中国微创外科杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的 探讨胸腔镜下胸交感神经切断术(endoscopic thoracic sympathotomy,ETS)治疗原发性手汗症(primary palmar hyperhidrosis,PPH)的效果。方法 2003年1月~2013年1月我们施行ETS治疗PPH 2206例,将不保留R2(切断R2~R4)和保留R2(单一切断R3或R4)分为A、B组进行回顾性比较。结果 均在胸腔镜下完成手术,无手术死亡和严重并发症。25例术后1周内出现一过性手掌多汗,均于1~2周内消失。2206例随访1~8年,中位时间4.5年。所有患者手掌伴头面部多汗症状及手部皮肤症状全部治愈,有效率100%;伴腋窝(41.8%)和足底(29.3%)多汗症状得到改善。3例术后1~2个月发生味觉性多汗,均于1年后自愈;5例术后9个月~5年复发,经再次手术治愈。转移性多汗(transfer hiperhidrosis,TH)Ⅰ级或轻度944例(42.8%),Ⅱ级或中度750例(34.0%),Ⅲ级或重度42例(1.9%),Ⅳ级或极重度又称致残性多汗18例(0.8%),TH发生率79.5%(1754/2206)。致残性多汗18例,随访时间1~8年,中位时间4.5年,仅好转2例。A、B组疗效满意度分别为94.2%(487/517)、98.1%(1657/1689),A组明显低于B组(Z=-4.704,P=0.000)。B组生活质量分级明显优于A组(Z=-5.425,P=0.000)。结论 ETS是治疗PPH安全、有效的微创方法。保留R2,降低胸交感神经切断平面,即单一切断R3或R4能显著降低Ⅲ~Ⅳ级转移性多汗发生率。一旦发生致残性多汗,难以治愈且长期存在,对患者危害性极大,应严格掌握ETS适应证。
[Abstract]:Objective to investigate the effect of thoracoscopic thoracic sympathesia on primary palmar hyperhidrosis (PPH). Methods from January 2003 to January 2013, we treated 2206 cases of PPH with ETS. The patients who did not retain R2 (cut off R2 + R4) and R2 (single cut R3 or R4) were divided into two groups: group A (n = 25) and group A (n = 25). Results all the patients underwent thoracoscopic surgery, and there were no operative death and severe complications in 25 patients with transient hyperhidrosis of the palms within 1 week after operation. All patients were followed up for 1 to 8 years in 1 to 2 weeks. The median time was 4.5 years. All the patients were cured with hyperhidrosis and skin symptoms. The effective rate was 100% (41.8% with axillary armpit) and 29.3% of plantar) hyperhidrosis occurred 1 ~ 2 months after operation in 3 cases, and 5 cases recurred from 9 months to 5 years after 1 year of self-healing, and the symptoms of hyperhidrosis were improved 1 ~ 2 months after operation. After reoperation, there were 944 cases of metastatic hyperhidrosis th (鈪，

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