微小双孔法胸腔镜双侧胸交感神经链切断术在治疗手汗症中的应用  

Micro-double-port endoscopic thoracic sympathectomy for treatment of primary palmar hyperhidrosis:report of 25 cases

作　　者：刘学海 李彦宁 王江龙 黄柯杰 李坤 LIU Xuehai;LI Yanning;WANG Jianglong;HUANG Kejie;LI Kun(Department of Thoracic Surgery,Army Medical Center of PLA,Chongqing,400042,China)

机构地区：[1]陆军特色医学中心胸外科,重庆400042

出　　处：《陆军军医大学学报》2022年第13期1390-1394,共5页Journal of Army Medical University

基　　金：陆军特色医学中心人才创新能力培养计划(2019CXJSC008)。

摘　　要：目的总结微小双孔法胸腔镜双侧胸交感神经链切断术在治疗手汗症中的临床应用。方法回顾性分析2021年4月至2022年3月于陆军特色医学中心胸外科接受微小双孔法胸腔镜双侧胸交感神经链切断术的25例患者的临床资料,其中男性9例,女性16例,年龄(23.0±5.1)岁,术中于第3或4肋间,腋前线和腋中线分别取两条0.5 cm切口,置入两枚5 mm穿刺器,使用5 mm针型胸腔镜,建立人工气胸下手术。结果25例患者均手术顺利,术后均正常出院,1例患者术后出现右侧少量气胸(术后12 d复查胸片检查提示气胸吸收),手汗及伴随部位多汗明显减少,手温升高达到预期;其中手术时间(23.2±4.7)min,术中出血量(4.2±2.3)mL,术后住院时间(0.6±0.4)d,术后疼痛评分(1.0±0.6)分,治疗有效率100%,效果满意度100%,15例患者术后出现轻度代偿性多汗。结论微小双孔法胸腔镜双侧胸交感神经链切断术治疗手汗症,切口小且美观,操作安全便捷,手术时间和术后住院时间短,术后无明显疼痛感,效果满意。ObjectiveTo summarize the clinical application of micro-double-port endoscopic thoracic sympathectomy in treatment of primary palmar hyperhidrosis.MethodsClinical data of 25 patients with primary palmar hyperhidrosis undergoing sympathectomy in our department from April 2021 to March 2022 were collected and retrospectively analyzed.They were 9 males and 16 females,at an age of 23.0±5.1(15,35)years.During the operation,two 0.5-cm incisions were made at the anterior axillary line and the mid-axillary line of the 3rd or 4th intercostal space,then two 5-mm trocars were placed,and a 5-mm needle-type thoracoscope was used to establish an artificial pneumothorax.R3 and R4 thoracic sympathetic chains were transected.ResultsAll 25 patients successfully received the operation and were discharged upon recovery.One patient developed a small amount of pneumothorax on the right side after operation,and re-examination with chest X-ray filming showed that the pneumothorax was absorbed in 12 d after operation.The symptoms of hyperhidrosis on the hands all disappeared,and hand temperature was increased as expected.The operation time was 23.2±4.7 min,the intraoperative blood loss was 4.2±2.3 mL,the postoperative hospital stay was 0.6±0.4 d,and the postoperative pain score was 1.0±0.6.The treatment effective rate was 100%,and the satisfaction of outcome was 100%.Fifteen patients had mild compensatory hyperhidrosis postoperatively.ConclusionIn treatment of primary palmar hyperhidrosis,micro-double-port endoscopic thoracic sympathectomy is characterized by small incision,safe and easy operation,short operation time and postoperative hospital stay,and no obvious pain and more satisfying outcomes.

关 键 词：微小双孔法 手汗症 电视胸腔镜 胸交感神经链切断术 

分 类 号：R443.8[医药卫生—诊断学] R651.4[医药卫生—临床医学] R758.74