背景:内窥镜胸交感神经切除术是目前原发性上肢多汗症的最佳治疗方法,但是潜在的不良影响,特别是补偿性出汗的发展,是一个令人担忧的问题,通常排除手术作为一种确定的治疗方法。本研究旨在评估两阶段单侧和一阶段双侧胸腔镜交感神经切除术的长期结果。
方法:从1995年11月至2011年2月,261例严重手掌和/或腋窝多汗症患者接受了内镜下交感神经切除术,随访至少4年。一百二十六名患者接受了一期双侧治疗,单孔电视胸腔镜交感神经切断术(一期组),135例患者接受了两期单侧,单端口电视胸腔镜交感神经切除术,手术之间的平均时间间隔为四个月(两阶段组)。
结果:术后平均随访时间为7.2年(范围,4-9年)。一阶段组中有16例患者(12.7%),两阶段组中有15例患者(11.1%)患有心动过缓(P=0.15)。复发发生在一个阶段组中的三名患者(2.4%)和两个阶段组中的一名(0.7%)(P=0.09)。一阶段组8例(6.3%)和两阶段组11例(8.1%)发生面部潮红或热疗。在一阶段组中有27例患者(21.4%)发生代偿性出汗,在两阶段组中有6例患者(4.4%)发生代偿性出汗(P=0.0001)。然而,在随访期间,两阶段组中有5例患者(83.3%)恢复了代偿性出汗,一阶段组中有9例(33.35%)(Log-rank检验P=0.016;HR,7.196;95%CI,1.431-36.20)。一阶段组中至少有90%的患者在手术后三年观察到术后生活质量(QoL)评分改善,两阶段组中至少有95%的患者(P=0.001)。
结论:对于手汗症和腋窝多汗症患者,在两阶段单侧和一阶段双侧交感神经切除术后,代偿性出汗似乎在随访期间得到改善,恢复率更高。
BACKGROUND: Endoscopic thoracic sympathectomy is currently the best treatment for primary upper extremity hyperhidrosis, but the potential for adverse effects, particularly the development of compensatory sweating, is a concern and often precludes surgery as a definitive therapy. This study aims to evaluate long-term results of two-stage unilateral versus one-stage bilateral thoracoscopic sympathectomy.
METHODS: From November 1995 to February 2011, 261 patients with severe palmar and/or axillary hyperhidrosis underwent endoscopic sympathectomy with a follow-up of at least 4 years. One-hundred and twenty-six patients received one-stage bilateral, single port video-assisted thoracoscopic sympathectomy (one-stage group) and 135 patients underwent two-stage unilateral, single-port video-assisted thoracoscopic sympathectomy, with a mean time interval of four months between the procedures (two-stage group).
RESULTS: The mean postoperative follow-up period was 7.2 years (range, 4-9 years). Sixteen patients (12.7%) in the one-stage group and 15 patients (11.1%) in the two-stage group suffered from bradycardia (P=0.15). Recurrences occurred in three patients (2.4%) in the one-stage group and one (0.7%) in the two-stage group (P=0,09). Facial flushing or hyperthermia occurred in eight patients (6.3%) in the one-stage group and 11 (8.1%) of the two-stage group. Compensatory sweating occurred in 27 patients (21.4%) in the one-stage group and six patients (4.4%) in the two-stage group (P=0.0001). However, compensatory sweating recovered in five patients (83.3%) in the two-stage group versus nine (33.35%) in one-stage group during the follow-up period (Log-rank test P=0.016; HR, 7.196; 95% CI, 1.431-36.20). An improvement in postoperative quality of life (QoL) scores was observed in at least 90% of patients at three years after surgery in the one-stage group and at least 95% of patients in the two-stage group (P=0.001).
CONCLUSIONS: Compensatory sweating seems to improve during the follow-up period with a higher recovery rate after two-stage unilateral versus one-stage bilateral sympathectomy for patients with palmar and axillary hyperhidrosis.