31例胸腔镜下T_3+T_4切断术治疗手汗症的临床效果评价  

Clinical Evaluation of 31 T_3+T_4 Thoracoscopic Sympathectomy Cases for Palmar Hyperhidrosis

作　　者：廖宇飞 叶霖[2] LIAO Yu fei;YE lin(Department of Thoracic Surgery,the First People＇s Hospital of J iangxia District,Wuhan Hubei China,43020)

机构地区：[1]江夏区第一人民医院协和江南医院胸外科,湖北武汉430200 [2]华中科技大学同济医学院附属协和医院科研处

出　　处：《华南国防医学杂志》2018年第8期527-531,共5页Military Medical Journal of South China

基　　金：湖北省自然科学基金项目(2016CFB356);湖北省卫生计生委科研基金项目(WJ2017Q023)

摘　　要：目的探讨胸腔镜下第三胸椎(T_3)+第四胸椎(T_4)交感神经干切断术及旁路神经纤维切断术对手掌温度的影响,同时评价术后的疗效。方法自2012-04/2018-01月江夏区第一人民医院31例手汗症患者施行胸腔镜下T_3+T_4交感神经干切断术及旁路神经纤维(Kuntz束)切断术,分为左侧组即左侧手术时按T_3、T_4及Kuntz束分别顺序切断,右侧组即右侧手术时按T_4、T_3及Kuntz束分别顺序切断。于术前、切断T_3、切断T_4及切断旁路神经纤维(Kuntz束)后5 min分别检测左、右手掌掌侧温度,观察其变化。结果两组患者术后手掌掌侧温度均较术前增高1~3(2.1±0.7)℃(P<0.05)。左侧组升高(2.2±0.7)℃,右侧组升高(2.1±0.8)℃(P<0.05),手掌多汗症状消失。左侧切断T_3后5 min掌温升高(1.9±0.3)℃(P<0.05),再切断T_4及Kuntz束后5 min掌温较T_3切断后手温可继续升高(0.5±0.2)℃(P<0.05);右侧切段T_4后5 min掌温升高(1.8±0.3)℃(P<0.05),再切段T_3及Kuntz束后5 min掌温较T_4切断后手温可继续升高(0.4±0.3)℃(P<0.05)。左右两侧掌温均升高明显,两组对比无统计学差异(P>0.05)。结论T_3、T_4分别切断或联合切断均可使掌温升高、疗效可靠;胸腔镜下T_3+T_4交感神经干切断术及旁路神经纤维切断术治疗手汗症是一种微创、安全、有效的方法。Objective To discuss the palm temperature changes and postoperative effect of the 3 rd thoracic（T3）＋the 4 th thoracic（T4）thoracoscopic sympathectomy and bypass fiber resection for the treatment of palmar hyperhidrosis.Methods From April 2012 to January 2018,a total of 31 palmar hyperhidrosis patients who went through T3＋ T4 thoracoscopic sympathectomy plus bypass fiber（Kuntz fiber）resection were divided into two groups.Group L was operated on left thorax and cut in the order T3,T4,Kuntz fiber.Group R was operated on right thorax and cut in the order T4,T3,Kuntz fiber.Palm temperatures on both sides were detected at pre-operation,five minutes after cutting T3 or T4 and Kuntz fiber resection,and the changes were observed.Results Palmaris temperatures of two groups were all increased 1-3（2.1±0.7）℃（P〈0.05）.The temperature of group L increased（2.2±0.7）℃（P〈0.05）,the temperature of group R increased（2.1±0.8）℃（P〈0.05）,and palm hyperhidrosis symptoms disappeared.The palm temperature was obviously higher at five minutes after left T3 resection[（1.9±0.3）℃,（P〈0.05）],and compared with cutting T3,the palm temperature continued to rise after cutting T4 and Kuntz fiber resection[（0.5±0.2）℃,P〈0.05].The palm temperature remarkablely increased at five minutes after cutting right T4[（1.8±0.3）℃,（P〈0.05）],and the palm temperature continued to rise at five minutes after cutting T3 and Kuntz fiber resection[（0.4±0.3）℃,P〈0.05].No significantly differences were found in both sides of palm temperatures（P〉0.05）.Conclusion T3 and T4 separately or jointly resection both can increase the palm temperatures remarkably and reliably.Thoracoscopic T3＋ T4 sympathectomy and bypass fiber resection is a minimally invasive,safe and efficient treatment for palmar hyperhidrosis.

关 键 词：手汗症 交感神经干切断术 胸腔镜 掌温检测 

分 类 号：R655[医药卫生—外科学]