针型胸腔镜胸交感神经干切断术治疗手汗症  

Needlescopic thoracic sympathicotomy for palmar hyperhidrosis

作　　者：魏翔[1] 潘铁成[1] 李军[1] 汤应雄[1] 胡敏[1] 陈涛[1] 刘立刚[1] 徐利军[1] OMO Alfred 

机构地区：[1]华中科技大学同济医学院附属同济医院胸心外科,武汉430030

出　　处：《中华外科杂志》2006年第14期949-951,共3页Chinese Journal of Surgery

摘　　要：目的探讨针型胸腔镜胸交感神经切断术治疗手汗症的安全性和有效性。方法2004年3月—2005年4月,采用2 mm针型胸腔镜和器械治疗手汗症患者62例,其中男性23例、女性39例,年龄12～53岁,平均23岁。16例患者为手掌中度出汗,46例为重度出汗；8例合并明显腋下出汗。全身麻醉双腔气管插管,依次完成双侧胸交感神经于切断术,对单纯手汗症,仅将位于第2和第3肋骨头表面的交感神经干切断；对合并腋下多汗者,同时切断第4肋骨头表面的交感神经干,术中通过手掌温度和血流量监测判断疗效。结果全组手术顺利,术毕患者手掌多汗的症状即消失,术中监测交感神经干切断前后手掌温度平均升高2．4℃,手掌血流量明显增加。术后平均住院1．2 d。54例(87%)患者1周内恢复正常的学习、工作或生活。随访1～13个月,平均6．3个月,手汗症状无一例复发,足底多汗和腋下出汗均有明显好转,26例(42%)患者出现代偿性多汗,均能耐受。结论针型胸腔镜胸交感神经干切断术治疗手汗症安全、有效,较常规胸腔镜手术更为微创。Objective To evaluate the safety and efficacy of needlescopic thoracic sympathicotomy for palmar hyperhidrosis. Methods From March 2004 to April 2005, 62 patients, including 23 men and 39 women with a mean age of 23 years（ ranged from 12 to 53 years）, underwent bilateral needlescopic thoracic sympathicotomy. Among all the patients 8 cases had accompanied axillary hyperhidrosis. The degree of palmar sweating was moderate in 16 cases and severe in 46 cases. The sympathetic chain on the body of the second and third ribs in all patients was cauterized and divided; the chain on the fourth rib in those with axillary hyperhidrosis was also severed. Intraoperative changes in palmar temperature and blood flow were recorded. Results Sympathicotomies were successful, and dry limbs were immediately achieved in all patients after surgery. There were no mortality or life-threatening complication, however 1 patient developed moderate pneumothorax which resolved soon after chest drainage. After all procedures, palmar blood perfusion increased significantly and mean palmar temperature elevated by 2. 4~C. The mean operative duration was 65 min, and the mean postoperative hospital stay was 1.2 days. No recurrence of palmar hyperhidrosis occurred after a mean follow-up of 6. 3 months （ranged from 1 to 13 months）. Compensatory sweating was found in 26 patients, but the symptoms were mostly tolerable and required no further treatment. Conclusion Needlescopic thoracic sympathicotomy is a safe and effective technique for palmar hyperhidrosis, which is less invasive than conventional video-assisted thoracic surgery.

关 键 词：胸外科学 电视辅助 交感神经切除术 多汗症 手足汗出 

分 类 号：R655[医药卫生—外科学]