本文關(guān)鍵詞： 手汗癥 胸腔鏡下胸交感神經(jīng)切斷術(shù) 轉(zhuǎn)移性多汗　出處：《中國微創(chuàng)外科雜志》2017年02期 　論文類型：期刊論文

【摘要】：目的 探討胸腔鏡下胸交感神經(jīng)切斷術(shù)(endoscopic thoracic sympathotomy,ETS)治療原發(fā)性手汗癥(primary palmar hyperhidrosis,PPH)的效果。方法 2003年1月~2013年1月我們施行ETS治療PPH 2206例,將不保留R2(切斷R2~R4)和保留R2(單一切斷R3或R4)分為A、B組進(jìn)行回顧性比較。結(jié)果 均在胸腔鏡下完成手術(shù),無手術(shù)死亡和嚴(yán)重并發(fā)癥。25例術(shù)后1周內(nèi)出現(xiàn)一過性手掌多汗,均于1~2周內(nèi)消失。2206例隨訪1~8年,中位時(shí)間4.5年。所有患者手掌伴頭面部多汗癥狀及手部皮膚癥狀全部治愈,有效率100%;伴腋窩(41.8%)和足底(29.3%)多汗癥狀得到改善。3例術(shù)后1~2個(gè)月發(fā)生味覺性多汗,均于1年后自愈;5例術(shù)后9個(gè)月~5年復(fù)發(fā),經(jīng)再次手術(shù)治愈。轉(zhuǎn)移性多汗(transfer hiperhidrosis,TH)Ⅰ級或輕度944例(42.8%),Ⅱ級或中度750例(34.0%),Ⅲ級或重度42例(1.9%),Ⅳ級或極重度又稱致殘性多汗18例(0.8%),TH發(fā)生率79.5%(1754/2206)。致殘性多汗18例,隨訪時(shí)間1~8年,中位時(shí)間4.5年,僅好轉(zhuǎn)2例。A、B組療效滿意度分別為94.2%(487/517)、98.1%(1657/1689),A組明顯低于B組(Z=-4.704,P=0.000)。B組生活質(zhì)量分級明顯優(yōu)于A組(Z=-5.425,P=0.000)。結(jié)論 ETS是治療PPH安全、有效的微創(chuàng)方法。保留R2,降低胸交感神經(jīng)切斷平面,即單一切斷R3或R4能顯著降低Ⅲ~Ⅳ級轉(zhuǎn)移性多汗發(fā)生率。一旦發(fā)生致殘性多汗,難以治愈且長期存在,對患者危害性極大,應(yīng)嚴(yán)格掌握ETS適應(yīng)證。
[Abstract]:Objective to investigate the effect of thoracoscopic thoracic sympathesia on primary palmar hyperhidrosis (PPH). Methods from January 2003 to January 2013, we treated 2206 cases of PPH with ETS. The patients who did not retain R2 (cut off R2 + R4) and R2 (single cut R3 or R4) were divided into two groups: group A (n = 25) and group A (n = 25). Results all the patients underwent thoracoscopic surgery, and there were no operative death and severe complications in 25 patients with transient hyperhidrosis of the palms within 1 week after operation. All patients were followed up for 1 to 8 years in 1 to 2 weeks. The median time was 4.5 years. All the patients were cured with hyperhidrosis and skin symptoms. The effective rate was 100% (41.8% with axillary armpit) and 29.3% of plantar) hyperhidrosis occurred 1 ~ 2 months after operation in 3 cases, and 5 cases recurred from 9 months to 5 years after 1 year of self-healing, and the symptoms of hyperhidrosis were improved 1 ~ 2 months after operation. After reoperation, there were 944 cases of metastatic hyperhidrosis th (鈪，

本文編號：1505164