3mm胸腔镜联合针型电凝钩治疗原发性手汗症临床效果的回顾性队列研究  

Clinical effect of 3 mm thoracoscope combined with needle electrocoagulation hook in the treatment of primary palmar hyperhidrosis: A retrospective cohort study

作　　者：王宏宾 蔺瑞江 马敏杰[1,2,3,4] 曹雄[1,3,4] 韩彪 WANG Hongbin;LIN Ruijiang;MA Minjie;CAO Xiong;HAN Biao(Department of Thoracic Surgery,The First Hospital of Lanzhou University,Lanzhou,730000,P.R.China;The First Clinical Medical College of Lanzhou University,Lanzhou,730000,P.R.China;Major in Research and Development and Application of Key Technologies in Thoracic Surgery Gansu International Science and Technology Cooperation Base,Lanzhou,730000,P.R.China;Gansu Provincial Medical Quality Control Center of Thoracic Surgery,Lanzhou,730000,P.R.China)

机构地区：[1]兰州大学第一医院胸外科,兰州730000 [2]兰州大学第一临床医学院,兰州730000 [3]胸外科关键技术研发与应用专业甘肃省国际科技合作基地,兰州730000 [4]甘肃省胸外科医疗质量控制中心,兰州730000

出　　处：《中国胸心血管外科临床杂志》2022年第3期311-317,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：甘肃省青年科技基金(21JR1RA107);甘肃省自然科学基金(21JR1RA118)。

摘　　要：目的探讨3 mm胸腔镜联合针型电凝钩胸交感神经离断术在无管化条件下治疗原发性手汗症的临床效果。方法回顾性分析2017年9月—2021年7月于兰州大学第一医院行手术治疗的77例原发性手汗症患者的临床资料,其中男50例、女27例,平均年龄(23.60±5.60)岁。36例患者行无管化条件下3 mm胸腔镜联合针型电凝钩胸交感神经离断术(观察组);41例患者行常规胸腔镜下胸交感神经离断术(对照组)。比较两组患者基线资料、围手术期资料及术后12 h情况评估结果。结果 77例患者均顺利完成手术,无中转开胸,无术中大出血,观察组无中转气管插管。观察组术前麻醉时间[19.00(17.00,23.75)min vs. 25.00(21.00,27.00)min,P=0.001]、手术时间[22.50(21.00,25.75)min vs. 26.00(23.50,28.50)min,P=0.001]、术后住院时间[2.00(1.00,2.00)d vs. 2.00(1.00,3.00)d,P=0.012]较对照组短;术中出血量[5.00(2.25,5.00)mL vs. 6.00(5.00,10.00)mL,P=0.003]、术后疼痛指数[2.00(1.00,2.00)vs. 3.00(2.00,3.00),P=0.001]、住院费用[(14 246.58±879.28)元vs.(15 085.90±827.15)元,P<0.001]及术后炎症指标:白细胞计数[(12.96±2.32)×10^(9)/L vs.(14.47±2.05)×10^(9)/L,P=0.003]、中性粒细胞百分比(76.31%±5.40%vs. 79.97%±7.12%,P=0.014)较对照组明显减少或降低。两组患者术后主要并发症及不良后果发生率差异无统计学意义(P>0.05)。在术后12 h情况评估中,观察组术后开始下床时间[2.00(1.00,2.00)h vs. 2.00(2.00,3.00)h,P=0.017]、术后进食水时间[1.50(1.00,2.00)h vs. 2.00(1.00,3.00)h,P=0.005]较对照组短,术后12 h心率[(80.25±14.42)次/min vs.(91.07±15.08)次/min,P=0.002]及术后12 h头晕、恶心等不适症状发生情况(5.6%vs. 25.0%,P=0.040)较对照组减少;两组患者术后12 h血氧饱和度(未吸氧状态)[97.00%(95.25%,98.00%)vs. 97.00%(96.00%,98.00%),P=0.763]差异无统计学意义。结论与常规胸腔镜下胸交感神经离断术相比,无管化条件下的3 mm胸腔镜联合针型电凝钩胸交�Objective To explore the clinical effect of tubeless 3 mm ultra-fine thoracoscope combined with needle electrocoagulation hook thoracic sympathicotomy in the treatment of primary palmar hyperhidrosis. Methods The clinical data of 77 patients with primary palmar hyperhidrosis who underwent surgery in the First Hospital of Lanzhou University from September 2017 to July 2021 were retrospectively analyzed, including 50 males and 27 females, with an average age of 23.60±5.60 years. A total of 36 patients were treated with tubeless 3 mm ultra-fine thoracoscopic electrocoagulation hook thoracic sympathicotomy(an observation group), and 41 patients were treated with conventional thoracoscopic thoracic sympathicotomy(a control group). The baseline data, perioperative data and the results of 12 hours after operation were compared between the two groups. Results All the 77 patients completed the operation successfully, no conversion to thoracotomy, no intraoperative bleeding, and no conversion to endotracheal intubation in the observation group. In the observation group, the time of anesthesia before operation [19.00(17.00, 23.75) min vs. 25.00(21.00, 27.00) min, P=0.001] and postoperative hospital stay [2.00(1.00, 2.00) d vs. 2.00(1.00, 3.00) d, P=0.012] were shorter than those in the control group. The operation time [22.50(21.00, 25.75) min vs. 26.00(23.50, 28.50) min,P=0.001], intraoperative blood loss [5.00(2.25, 5.00) mL vs. 6.00(5.00, 10.00) mL, P=0.003], postoperative pain index [2.00(1.00, 2.00) vs. 3.00(2.00, 3.00), P=0.001], hospitalization cost(14 246.58±879.28 yuan vs. 15 085.90±827.15 yuan, P<0.001)and postoperative inflammation index: white blood cell count [(12.96±2.32)×10^(9)/L vs.(14.47±2.05)×10^(9)/L, P=0.003],percentage of neutrophils(76.31%±5.40% vs. 79.97%±7.12%, P=0.014) were significantly lower or less than those in the control group. There was no significant difference in the incidence of major postoperative complications or adverse consequences between the two groups(P>0.05). In the evalua

关 键 词：胸腔镜下胸交感神经离断术 原发性手汗症 无管化 回顾性队列研究 

分 类 号：R655[医药卫生—外科学]