电视胸腔镜胸交感神经干切断术治疗手汗症50例  

Video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis:Report of 50 cases

作　　者：傅成国[1] 姜杰[1] 康健乐[1] 

机构地区：[1]厦门大学附属中山医院胸外科,厦门361004

出　　处：《中国微创外科杂志》2006年第9期657-658,共2页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨电视胸腔镜胸交感神经干切断术治疗手汗症疗效。方法双腔气管插管全麻，45°半坐位，两臂外展90°固定。术侧腋中线第5肋间做0．5～1．5cm切口为胸腔镜观察孔，腋前线第3肋间胸大肌后做0．3～0．5cm切口为操作孔，电视胸腔镜下行T2～T4交感神经干切断术。结果50例术后双手立即干燥、红润，手温升高0．2～4．6℃。3例术后少量气胸（肺压缩10％～20％），未发生霍纳综合征等严重并发症。31例术后3～15d出现代偿性多汗，轻度11例，中度20例，多汗部位前胸13例，后背11例，腹部2例，大腿4例，小腿1例。50例随访1～14个月，平均7个月，无复发。结论电视胸腔镜胸交感神经干切断术是治疗手汗症安全、可行、有效的方法。Objective To investigate curative effects of video-assisted thoracoscopic sympathectomy for the treatment of palmar hyperhidrosis. Methods Under general anesthesia with double-lumen endotracheal intubation, the patient was maintained at a 45° semi-sitting position with two upper limbs fixed on 90° abduction. An incision 0.5～1.5 cm in length was made on the midaxillary line at the fifth intercostal space to introduce the thoracoscope. Another incision 0.3～0.5 cm in length was made on the anterior axillary line at the third intercostal space as manipulation hole. Under video-assisted thoracoscopy, the sympathetic trunk on the T2～T4 level was amputated for treating palmar hyperhidrosis. Results The patient＇s palms became dry and warm immediately after surgery in all 50 patients. The temperature of the palm was increased by 0.2～4.6℃. Slight pneumothorax was encountered in 3 patients （lung compression, 10%～20% ）. Compensated hyperhidrosis occurred in 31 patients within 3～15 days after operation, including mild hyperhidrosis in 11 patients and moderate hyperhidrosis in 20 patients. The hyperhidrosis was located at the chest in 13 patients, back in 11 patients, abdomen in 2 patients, thigh in 4 patients, and shank in 1, respectively. There were no Horner＇ s syndrome and other severe complications after operation. None of patients recurred in follow-up observations. Conclusions Video-assisted thoracoscopic sympathectomy is a safe and reliable approach for the treatment of palmar hyperhidrosis.

关 键 词：胸交感神经干切断术 手汗症 

分 类 号：R655[医药卫生—外科学] R758.743[医药卫生—临床医学]