针孔胸腔镜下胸交感神经链切断术治疗手汗症的安全性与远期疗效  

Safety and long term efficacy of endoscopic thoracic sympathetic nerve transection in the treatment of hand sweat

作　　者：王沐廷[1] 李锐雄[1] 方忠民[1] 朱天翔[1] 蓝斌[1] 陈恕[1] 邱旭龙[1] 杨彦龙[1] 马陈声[1] 

机构地区：[1]汕头市中心医院心胸外科,广东515031

出　　处：《齐齐哈尔医学院学报》2016年第13期1681-1683,共3页Journal of Qiqihar Medical University

摘　　要：目的探讨针孔胸腔镜下胸交感神经干切断术治疗原发性手汗症的临床疗效及安全性。方法选取2012年6月至2013年5月在我院行胸腔镜的辅助下胸交感神经链切断术的原发性手汗症患者60例,所有患者均给予双腔气管插管单肺通气,记录手术开始前及手术过程中各时间段患者的平均动脉压（mean artery pressure,MAP）、心率（hemorheology,HR）、血氧饱和度（Sp O2）等情况,并观察患者的远期疗效及安全性。结果所有患者平均手术时间为（32.5±11.3）min;术中平均出血量为（9.8±2.6）ml;轻度疼痛9例（15.00%）,中度疼痛7例（11.67%）,无疼痛44例（73.33%）;术后患者的手掌温度较术前升高（2.5±0.6）℃;平均住院时间（2.1±0.9）天;患者低潮气量的通气时间平均为（7.4±2.3）min,最长时间为15min。所有患者的MAP、HR在各时间段均在正常范围内波动,Sp O2始终保持在97%~100%,且差异无统计学意义（P〉0.05）;所有患者在术后进行1~34个月的随访,中位随访时间为18个月,发现行T3切断与行T3T4切断患者出现代偿性出汗的发生率对比差异无统计学意义（P〉0.05）,术后所有患者的手汗症均全部消失,有效率达100%,行T3切断与行T3T4切断患者之间远期疗效差异无统计学意义（P〉0.05）。结论在针孔胸腔镜下胸交感神经链切断术治疗原发性手汗症安全有效,选择切断T3与切断T3T4神经链在术后代偿性多汗及远期疗效无明显差异,旨在保证手汗症疗效。Objective To investigate the clinical efficacy and safety of the treatment of the primary hand sweat by the treatment of the thoracic sympathetic trunk with the pinhole assisted thoracic surgery. Methods 60 cases of patients suffered from primary hyperhidresis and received thoracoscopic assisted descending thoracic sympathetic nerve stem transection in our hospital during June 2012 and May 2013 were selected. All patients were given double lumen endotracheal intubation and one lung ventilation. Mean arterial pressure （ mean artery pressure （ MAP）, heart rate （HR） and Blood oxygen saturation （ SpO2 ） before the start of the operation and during the operation period were recorded, and the long turn efficacy and safety were observed. Results For all the patients, the average operation time was （32.5 ＋ 11.3 ） min, during the operation the average amount of bleeding was （9. 8 ＋ 2.6） ml. 9 cases suffering mild pain （ 15.00% ） , 7 eases suffered from moderate pain （ 11.67% ）, no pain in 44 cases （73.33%）. Postoperative hand temperature elevated （2.5 ~ 0.6） ~C, average hospitalization time was （2.1 ~ 0.9 ） days. Low tidal volume ventilation time was （7.4 ~ 2.3 rain） on average, the longest time was 15 rain. Map and HR were within the normal range, SpO2 was always maintained between 97% and 100% ,the difference was not statistieal/y significant （ P 〉 0. 05 ）. All the patients were followed - up for 34 months after operation, the modian following- up time was 18 months. The difference of occurrence of compensatory sweating between T3 and T3T4 cut not statistically significant （P 〉 0. 05 ）. Palmar hyperhidrosis all disappear, effective rate was 100%. Difference of long - term efficacy between T3 and T3T4 cut patients with no statistically significant （P 〉 0. 05）. Conclusions In the ease of the pinhole thoracic sympatheetomy is safe and effective for the treatment of primary hand sweat. The difference of long - term efficacy and the compensatory sweating rat

关 键 词：胸腔镜 交感神经链切断术 远期疗效 

分 类 号：R651.3[医药卫生—外科学]