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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。
Objective To investigate the effect of thoracoscopic endoscopic thoracic sympathotomy (ETS) on primary palmar hyperhidrosis (PPH). Methods From January 2003 to January 2013, we performed 2206 cases of PPH treated with ETS, and retrospectively compared the two groups without reserving R2 (cutting R2 ~ R4) and keeping R2 (single cutting R3 or R4). The results were completed under thoracoscopic surgery, no operative mortality and serious complications. One case of sweaty palms appeared in 25 cases within one week after operation, both disappeared in 1 ~ 2 weeks. 2206 cases were followed up for 1 to 8 years, with a median time of 4.5 years. All patients with palpitations head facial hyperhidrosis symptoms and hand skin symptoms were completely cured, with an efficiency of 100%; with axillary (41.8%) and plantar (29.3%) sweating symptoms are improved. Three patients developed taste hyperhidrosis 1 to 2 months after operation, both of them recovered after 1 year. Five patients relapsed 9 months to 5 years after operation and were cured by reoperation. Grade I or mild 944 cases (42.8%) of transfer hiperhidrosis (TH), 750 cases (34.0%) of grade Ⅱ or moderate, grade Ⅲ or severe 42 cases (1.9%), grade Ⅳ or very severe Also known as disabling perspiration in 18 cases (0.8%), TH incidence 79.5% (1754/2206). 18 cases of disabling perspiration, follow-up time of 1 to 8 years, the median time of 4.5 years, only 2 cases improved. The satisfaction rate of group A and group B was 94.2% (487/517) and 98.1% (1657/1689), respectively, while that of group A was significantly lower than that of group B (Z = -4.704, P = 0.000). The quality of life in group B was significantly better than that in group A (Z = -5.425, P = 0.000). Conclusion ETS is a safe and effective minimally invasive method for the treatment of PPH. Preserving R2 and decreasing the transection plane of thoracic sympathectomy, that is, the single cutting off of R3 or R4 can significantly reduce the incidence of grade Ⅲ ~ Ⅳ metastatic hyperhidrosis. In the event of disabling perspiration, difficult to cure and long-term existence of great harm to patients should be strictly controlled ETS indications.