经脐超细胃镜T3、T4交感神经毁损术治疗原发性手汗症疗效比较  

Effects of T3 or T4 sympathectomy through transumbilical-ultrafine gastroscopy for primary palmar hyperhidrosis

作　　者：李达周[1] 陈飞[1] 陈炜生[2] 杨胜生[2] 王雯[1] 

机构地区：[1]南京军区福州总医院消化内科 福建医科大学临床医学院,福州350025 [2]南京军区福州总医院心胸外科

出　　处：《中华消化内镜杂志》2015年第11期725-728,共4页Chinese Journal of Digestive Endoscopy

基　　金：南京军区医学科技创新重大项目（12235）

摘　　要：目的比较经脐超细胃镜下T3、T4交感神经毁损术治疗原发性手汗症的效果。方法选择84例原发性重度手汗症患者，随机分2组，T3组（42例），T4组（42例），组间均衡可比，均行经脐-膈肌进入胸腔行超细胃镜下双侧交感神经毁损术。记录手术时间、住院时间，于术后第1、3、6、12个月随访记录患者术后手汗、腋汗改善情况及并发症发生情况。结果84例患者均顺利完成手术，平均手术时间为T3组（55．02±10．61）min，T4组（55．36±10．51）min（P〉0．05）。2组平均住院时间均为1．5d。术后随访12个月，2组均没有观察到膈疝、脐疝、霍纳综合症等严重并发症发生，无术后手汗症复发、重度代偿性多汗。术后T3组手汗症、腋汗症、足汗改善者分别为42／42例、10／16例、21／29例；T4组手汗症、腋汗症、足汗改善者分别为42／42例、16／17例、18／28例，T4组腋汗改善明显高于113组（P〈0．05）；术后T3组代偿性多汗16例，其中15例为轻度，1例为中度。T4组术后出现代偿性多汗7例，其中6例为轻度，1例为中度（P〈0．05）。结论利用超细胃镜行，T3、T4交感神经灼断术治疗原发性手汗症安全、有效、美观。二者对手汗症改善效果无差异，T4交感神经切断较T3交感神经切断术后发生代偿性多汗的概率低，腋汗改善更为确切。Objective To compare the efficacy of transumbilical-ultrafine gastroscope sympathecto- my for severe palmar hyperhidrosis using two distinct levels of T3 and T4. Methods A total of 84 cases with severe primary hyperhidrosis were randomly allocated to undergo either T3 sympathectomy treatment （ T3 group, n = 42 ） or T4 sympathectomy treatment （T4 group, n = 42 ）with no difference between the two groups. The operation time, postoperative hospital stay, patient＇s hands hyperhidrosis, axillary hyperhidro- sis, complications were recorded at follow-up in 1,3,6,12 months. Results Operation on 84 patients were successful with mean operative time of T3 group being 55. 02 ± 10. 61 rain and T4 group being 55.36 ±10. 51 min（P 〉0. 05）. The mean postoperative hospital stay were both 1.5 days. Patients were followed up for diaphragmatic hernia, umbilical hernia, Homer＇s syndrome and other serious complications for 12 months. No postoperative recurrence of palmar hyperhidrosis, severe compensatory sweating occurred in either group. The number of improved patients in T3 group＇s palmar hyperhidrosis, axillary hyperhidrosis, and foot hyperhidrosis were：42/42 cases,10/16 cases, 21/29 cases,while those in T4 group were：42/42 cases, 16/17 cases 18/28 cases. Axillary hyperhidrosis improved to a larger extent in T4 group than in T3 group （P 〈 0. 05 ）. There were 16 （ 15 mild and 1 moderate）compensatory sweating in I3 group and 7 （6 mild and 1 moderate） compensatory sweating in T4 group（P 〈 0. 05 ）. Conclusion T3 and T4 thoracic sympathectomy using transumbilical-uhrafine gastroscope for primary palmar hyperhidrosis are safe, effective, and feasible. T4 sympathectomy is more effective in improving axillary hyperhidrosis than T3 and shows lower occurrence of postoperative compensatory hyperhidrosis.

关 键 词：超细胃镜 原发性手汗症 交感神经毁损术 转移性出汗 

分 类 号：R655[医药卫生—外科学]