胸腔镜下不同节段交感神经切断术治疗手汗症的Meta分析

发布时间：2018-01-20 02:19

本文关键词： 胸腔镜下交感神经切断术手汗症代偿性多汗 Meta分析　出处：《山东医药》2017年06期 　论文类型：期刊论文

【摘要】：目的系统评价胸腔镜下不同节段交感神经切断术治疗手汗症的治疗效果。方法利用计算机检索比较不同节段胸腔镜下交感神经切断术(VTS)治疗手汗症的文献。对纳入的12篇文献进行资料提取和质量评价。根据最高手术节段将患者分为T_2组(含T_2、T_2~T_3、T_2~T_4节段)、T_3组(含T_3、T_3~T_4节段)和T_4组,采用Rev Man5.3、STATA软件比较T_2与T_3、T_3与T_4组的疗效差异,采用Review Manager 5.3软件进行Meta分析。结果共纳入12篇随机对照研究、1 561例患者,其中T_2组542例、T_3组767例、T_4组252例。Meta分析结果显示,T_2组与T_3组手术有效率和术后复发率无统计学差异,T_3组患者满意度(95%CI为0.13~0.63,P0.01)高于T_2组,代偿性多汗(95%CI为0.03~0.17,P0.01)、中重度代偿性多汗(95%CI为1.40~3.28,P0.01)的发生率低于T_2组;T_3组与T_4组手术有效率、满意度和术后复发率无统计学差异,T_4组代偿性多汗(95%CI为1.93~4.26,P0.01)、中重度代偿性多汗(95%CI为1.67~7.52,P0.01)、手过干(P0.05)的发生率低于T_3组。结论在胸腔镜下交感神经切断术中,切断T_4节段与切断T_2、T_3节段比较,在保证手术效果的同时,能明显降低术后并发症的发生,是治疗手汗症更好的选择。
[Abstract]:Objective to evaluate the therapeutic effect of different segmental sympathetic neurotomy under thoracoscopy in the treatment of palmar hyperhidrosis. Methods VTS was compared with different segments of thoracoscopic sympathetic neurotomy (VTS). Literature on the treatment of palmar hyperhidrosis. Data extraction and quality evaluation were carried out for 12 articles included. Patients were divided into two groups according to the highest operative segment: group T _ (2) (including T _ (2)). The Rev Man5.3 was used for the two groups: T2 / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T. STATA software was used to compare the difference of curative effect between T _ 2 and T _ T _ 3 / T _ T _ 3 and T _ S _ 4 groups. Meta analysis was carried out with Review Manager 5.3 software. Results A total of 1 561 patients were enrolled in 12 randomized controlled studies, including 542 patients in group T _ 2. Meta-analysis showed that there was no significant difference in the effective rate and recurrence rate between the two groups. The patient satisfaction (CI = 0.130.63, P 0.01) was higher in group T3 than that in group 2 (compensatory hyperhidrosis 95 CI = 0.03 0.17, P 0.01). The incidence of moderate and severe compensatory hyperhidrosis with CI of 1.40 and 3.28 (P 0.01) was lower than that of group 2. There was no significant difference in the effective rate, satisfaction and recurrence rate between the two groups. The compensatory hyperhidrosis 95 CI was 1.93% 4.26% (P 0.01). The CI of moderate and severe compensatory hyperhidrosis was 1.67 / 7.52 / P0.01a, and the incidence of P0.05 was lower than that of T3 group. Conclusion the incidence of thoracoscopic sympathectomy is lower than that of T3 group. It is a better choice to treat palmar hyperhidrosis by cutting T _ 4 segment and T _ 2T _ T _ 3 segment, which can ensure the effect of operation and reduce the occurrence of postoperative complications obviously at the same time, so it is a better choice to treat palmar hyperhidrosis by cutting off T _ 4 segment.
【作者单位】：南昌大学第二附属医院;
【基金】：国家自然科学基金资助项目(81560345)
【分类号】：R655
【正文快照】： 胸腔镜下交感神经切断术(VTS)具有创伤小、安全可靠、效果满意且持久等特点,是手汗症的标准外科治疗方式。VTS治疗手汗症的疗效与手术切断节段关系密切,其中最高手术节段的选择尤为关键。最高手术节段相同时,扩大手术范围并不能明显提高手术有效率或改变术后代偿性多汗等并发

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