手汗症胸交感神经切断术中掌温变化与术后疗效  

Sympathicotomy for palmar hyperhidrosis： the association between the intraoperative hand temperature change and the curative effect

作　　者：刘彦国[1] 郑夏[1] 崔健[2] 李晓 陈克终[1] 李剑锋[1] 黄宇清[2] 刘军[1] 王俊[1] 

机构地区：[1]北京大学人民医院胸外科胸部微创中心,100044 [2] 北京市海淀医院胸外科

出　　处：《中华胸心血管外科杂志》2015年第1期21-23,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 探讨手汗症患者术中掌温变化与术后疗效的关系,并分析以掌温变化预测疗效的可行性及科学性.方法 2012年7月至2013年4月经胸腔镜双侧胸交感神经切断术治疗的49例手汗症患者,术中测量交感神经切断前、切断后3、5、7、10、15及20 min同侧手掌温度,计算掌温上升最大值（Tmax）并以此作为评价指标.术后随访效果并进行相关性分析.结果 全组49例患者98侧手术均顺利,其中T4切断术77例次,T4＋T5切断术15例次,T3切断术6例次.行T4切断术77只手掌中Tmax＞1.5℃者25只,1.0℃～1.5℃者16只,≤1.0℃者36只.术后失访3例,有随访资料的T4切断术71只手掌中,效果满意67只（94.3％）,4只效果不满意者的Tmax值均≤1.0℃.但在全组≤1.0℃组中效果满意者占88.9％ （32/36）.结论 术中掌温变化与术后疗效有一定相关性,掌温上升不明显者术后效果不佳的概率偏高,但尚不能以掌温变化来预测疗效并指导术式选择.Objective To investigate the association between intraoperative palm temperature change and the curative effect of sympathicotomy,and to analyze its feasibility and efficacy.Methods Between July 2012 and April 2013,49 patients with palmar hyperhidrosis were treated with bilateral endoscopic sympathicotomy.Ipsilateral palm temperature was monitored before and at 3-5 minute increments after the sympathetic trunk was transected.The maximum temperature elevation （Tmax） was calculated and used for evaluation.Results Forty-nine patients underwent 98 sympathicotomies.There were 77 T4 sympathicotomies,15 T4 ＋ T5 sympathicotomies,and 6 T3 sympathicotomies.T4 group was focus of this study.Their Tmax was ≤ 1.0＆#176;C in36（46.7%）,1.0＆#176;C-1.5＆#176;C in 16（20.8%）,and 〉1.5＆#176;C in 25（32.5%） palms.46 patients were followed with complete efficacy data.Cure was achieved in 86 palms（93.4%）.Of the 71 palms which underwent T4 sympathicotomy,cure was achieved in 67 palms（94.3 %）.In those palms which did not achieve cure,the Tnax was less than 1.0＆#176;C in each case,while in palms with Tmax ≤ 1.0＆#176;C,88.9% were cured.Conclusion There is an association between intraoperative palmar temperature change and curative effect.Those without an obvious change in palm temperature after sympathicotomy have a lower probability of cure.However,palmar temperature change cannot be used to predict cure or guide surgical approach.

关 键 词：手汗症 交感神经切断术 温度 外科治疗 

分 类 号：R651.3[医药卫生—外科学]