原发性手掌多汗症(PPH)是一种慢性疾病,其特征是不受控制的手掌出汗超过生理需求。它会对患者的生活质量产生负面影响,并可能导致不同程度的心理问题。目前,PPH有多种治疗选择,其中开胸手术是一线治疗方法,已显示出良好的疗效。然而,由于这是一种需要全身麻醉的侵入性手术,并且通常伴随着高成本和严重的并发症,应该探索更好的替代方案。计算机断层扫描(CT)引导的胸交感神经射频热凝(RF-TC)经皮穿刺是一种有前途的替代治疗方法。这是一种微创手术,可以在局部麻醉下进行,并与快速恢复有关。然而,影响CT引导下经皮经胸交感神经RF-TC手术相关获益和结局持续时间的因素尚不清楚.
探讨CT引导下经皮胸交感神经射频TC治疗PPH患者的影响因素。
一项回顾性研究。
本研究在嘉兴大学附属医院疼痛科(嘉兴,中国)。
经嘉兴学院附属医院伦理委员会批准,对232例相应患者的数据进行了评估.采用Kaplan-Meier法进行生存分析。进行单变量和多变量分析以确定与PPH相关的因素并构建用于预测术后复发的列线图。进行与时间无关的受试者工作特征(ROC)曲线分析以评估列线图的预测能力。
在一年生存分析模型中,性别(HR=1.573,95CI:0.844至2.934),年龄(HR=0.965,95CI:0.915至1.018),病程(HR=0.960,95CI:0.908至1.015),手掌温度差(HR=0.377,95CI:0.287至0.495),灌注指数差异(HR=0.590,95CI:0.513至0.680)和多汗症疾病严重程度量表(HR=1.963,95CI:0.769至5.011)在单因素分析中被确定为有统计学意义的因素,而手掌温度差(HR=0.589,95CI:0.369至0.941)和灌注指数差(HR=0.357,95CI:0.588至0.968)是多变量Cox比例风险模型中的独立因素。在2年生存分析模型中,手掌温度差(HR=0.353,95CI:0.261至0.478),灌注指数差异(HR=0.589,95CI:0.510至0.680)和多汗症疾病严重程度量表(HR=1.964,95CI:0.771至5.006)是有统计学意义的因素,而手掌温度差(HR=0.507,95CI:0.321至0.799)和灌注指数差异(HR=0.789,95CI:0.625至0.995)是独立因素。
这项单中心回顾性研究受到样本量小的限制,随访时间短,以及非随机患者选择导致偏见的可能性。
掌温差异和灌注指数差异是影响PPH患者CT引导下交感神经RF-TC手术效果延长和术后复发的独立危险因素。
Primary palm hyperhidrosis (PPH) is a chronic disease characterized by uncontrolled palm-sweating exceeding physiological needs. It negatively impacts the quality of life of the patients and can lead to different degrees of psychological problems. Currently, there are a variety of treatment options for PPH, of which thoracotomy is a first-line treatment that has shown good efficacy. However, since it is an invasive procedure requiring general anesthesia and is often associated with high costs and serious complications, better alternatives should be explored. Computed tomography (CT)-guided percutaneous puncture of radiofrequency thermocoagulation (RF-TC) of the thoracic sympathetic nerve is a promising alternative treatment. It is a minimally invasive procedure that can be performed under local anesthesia and is associated with rapid recovery. However, the factors affecting the duration of the surgery-related benefits and outcomes of CT-guided percutaneous RF-TC of the thoracic sympathetic nerve are unclear.
To investigate the factors influencing the outcomes of CT-guided percutaneous RF-TC of the thoracic sympathetic nerve in patients with PPH.
A retrospective study.
This study was conducted at the Pain Department of Jiaxing University Affiliated Hospital (Jiaxing, China).
After approval by the Ethics Committee of the Affiliated Hospital of Jiaxing College, the data of 232 corresponding patients were assessed. The Kaplan-Meier method was used for survival analysis. Univariate and multivariate analyses were performed to identify factors associated with PPH and to construct a nomogram for predicting postoperative recurrence. Time-independent receiver operating characteristic (ROC) curve analyses were performed to assess the nomogram\'s predictive capacity.
In the one-year survival analysis model, gender (HR = 1.573, 95%CI: 0.844 to 2.934), age (HR = 0.965, 95%CI: 0.915 to 1.018), disease course (HR = 0.960, 95%CI: 0.908 to 1.015), palm temperature difference (HR = 0.377, 95%CI: 0.287 to 0.495), perfusion index difference (HR = 0.590, 95%CI: 0.513 to 0.680) and hyperhidrosis disease severity scale (HR = 1.963, 95%CI: 0.769 to 5.011) were identified as statistically significant factors in univariate analysis, while palm temperature difference (HR = 0.589, 95%CI: 0.369 to 0.941) and perfusion index difference (HR = 0.357, 95%CI: 0.588 to 0.968) were the independent factors in the multivariate Cox proportional hazards risk model. In the 2-year survival analysis model, palm temperature difference (HR = 0.353, 95%CI: 0.261 to 0.478), perfusion index difference (HR = 0.589, 95%CI: 0.510 to 0.680) and hyperhidrosis disease severity scale (HR = 1.964, 95%CI: 0.771 to 5.006) were the statistically significant factors while palm temperature difference (HR = 0.507, 95%CI: 0.321 to 0.799) and perfusion index difference (HR = 0.789, 95%CI: 0.625 to 0.995) were the independent factors.
This single-center retrospective study was limited by its small sample size, short follow-up time, and the possibility of bias resulting from the non-random patient selection.
Palm temperature difference and perfusion index difference were independent risk factors associated with prolonging the surgical benefits and reducing postoperative recurrence of CT-guided RF-TC of the sympathetic nerves in patients with PPH.