胸腔镜下胸交感神经链切断术治疗手汗症的临床研究
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摘要
目的:探讨胸腔镜下胸交感神经链切断术治疗手汗症疗效和术后并发症的发生率及预防措施。
方法:对2003年1月至2006年9月在我院行胸腔镜下胸交感神经链切断术的152例手汗症患者进行术后随访,并对其临床及随访资料进行相关分析。
结果: 152例患者中男66例,女86例;年龄13～60岁,平均27.88岁;少年组(13～17岁年龄段)13例,青年组(18～45岁年龄段)121例,中年组(46～60岁年龄段)18例。术前病情分级:中度57例(37.50%),重度95例(62.50%)。伴足底多汗127例(83.55%),伴腋窝多汗101例(66.45%)。42例伴不同程度手部皮肤疾患,包括汗疱疹28例(18.42%),蜕皮24例(15.79%),皲裂11例(7.24%)。全部患者术后手掌多汗症状消失,双手转为干爽温暖状;152例术后随访1～45个月,平均25.4月,85例回信,54例电话随访,7例门诊随访,失访6例,随访率96.05%。
1.中度组57例,治愈57例,有效率100%,复发0例;重度组89例,治愈89例,有效率100%,复发0例。伴足底多汗者127例,足汗症状缓解率67.72%(86/127);伴腋汗增多者101例,腋汗症状缓解率82.18%(83/101)。
2.转移性多汗
①少年组术后转移性多汗发生率为30.00%(3/10),青年组为28.81%(34/118),中年组为27.78%(5/18)。各组发生率比较,差异不具有显著性(P﹥0.05)。
②男性组术后转移性多汗发生率为29.69%(19/64),女性组为28.05%(23/82)。两组发生率比较,差异不具有显著性(P﹥0.05)。
③中度组术后转移性多汗发生率为17.54%(10/57),重度组为35.96%(32/89)。两组发生率比较,差异具有显著性(P﹤0.05)。
④中度组术后转移性多汗10例,其中半年内自愈者5例,自愈率为50.00%(5/10);一年内自愈者共7例,自愈率为70.00%(7/10);一年半内自愈者共8例,自愈率为80.00%(8/10)。重度组术后转移性多汗32例,其中半年内自愈者11例,自愈率为34.38%(11/32);一年内自愈者共16例,自愈率为50.00%(16/32);一年半内自愈者共22例,自愈率为68.75%(22/32)。同一时间段两组自愈率相比较,差异均不具有显著性(P>0.05)。
3.中度组合并手部皮肤疾患者16例,术后手部皮肤疾患消失15例,治愈率93.75%;重度组合并手部皮肤疾患者26例,术后手部皮肤疾患消失15例,治愈率57.69%。两组手部皮肤疾患治愈率相比,差异具有显著性(P﹤0.05)。
4.全组患者术后无血气胸,霍纳氏综合症等并发症,少数患者诉术后胸部隐痛,持续时间一般未超过两周。
结论:1.手术有效率100%,无一例复发。2.手术后疗效与术前病情分级无相关性,均可完全治愈。大部分患者足汗及腋汗术后可以缓解。3.术后转移性多汗的发生率与患者年龄及性别无相关性,而与术前病情分级有相关,重度组术后转移性多汗发生率高于中度组。术后转移性多汗的自愈时间和自愈率与术前病情分级无相关。大部分转移性多汗可以自愈。4.术前病情分级与伴随手部皮肤疾患术后恢复情况有相关,重度组皮肤疾患治愈率低于中度组。总之,胸腔镜下T_2～T_4交感神经链切断术是治疗手汗症有效,安全,微创的方法。
Objective: To investigate the outcomes, complications and preservation about ETS for PH.
Methods: Analyzing the results and complications about the 152 cases, who were received ETS for treating PH from Jan.2003 to Sep. , and were followed up.
Results: In 152 patiens after ETS, aged 13-60 years and 27.88 years on average; 13 juvenile (aged 13~17years), 121 youth (aged 18~45years), 18 middle age (aged 46~60years); 66 males, 86 females; 57 midrange, 95 serious-range; 127 FH, 101 AH. 42 of them went with disease on the hands, include 28 herpes, 24 exuviae, 11 rhagades. All of their hands became dry and warm after operation. 146 patiens were followed-up for 1 to 45 months, and 25.4 months on average: 7 of them were clincchekups, 54 of them were followed by phone, 85 of them by mail. The follow-up rate is 96.05%. The total results: No recurrence, hemopneumothorax, Horner’s syndrome and other serious complications.
The cure rate that for midrange and serious-range PH case were 100% (57/57, 89/89). That for FH and AH were 67.72%(86/127) and 82.18%(83/101) respectively.
The incidence of CH in patiens with different ages is 30.00%(juvenile, 3/10)、28.81%(youth, 34/118) and 27.78%(middle age, 5/18). (P>0.05). The incidence of CH in patiens with different sex is 29.69%(males, 19/64) vs 28.05%(females, 23/82). (P>0.05). The incidence of CH in patiens with different range is 17.54%(midrange, 10/57) vs 35.96%(serious-range, 32/89). (P﹤0.05). In 57 patiens with midrange PH, 10 CH. 5 of them were self-cure in half a year, 7 in one year, 8 in one and a half year; in 89 patiens with serious-range PH, 32 CH, 11 of them were self-cure in half a year, 16 in one year, 22 in one and a half year. (P>0.05).
In 16 patiens midrange PH with disease on hands, 15 curing; in 26 patiens serious-range PH with disease on hands, 15 curing. Significantly different.
A few of them complained pain on chest, few of that last for two weeks.
Conclusion: 1.The curing rate is 100%, none recurred. 2. There are no association among the outcome and the range of PH. Most of the FH and AH can be cured following the curing of PH. 3. There are no association among the incidence of CH and the age or sex. There are some association among the range of PH and the incidence of CH , but no association among the range of PH and the self-cure time. The serious-range has the higher rate of CH than midrange. 4. There are some association among the range of PH and the cure about disease on hands. The serious-range has the lower rate of cruing than midrange. Above all, It is effective, safer and mini-trauma that ETS for treating PH.
方法:对2003年1月至2006年9月在我院行胸腔镜下胸交感神经链切断术的152例手汗症患者进行术后随访,并对其临床及随访资料进行相关分析。
结果: 152例患者中男66例,女86例;年龄13～60岁,平均27.88岁;少年组(13～17岁年龄段)13例,青年组(18～45岁年龄段)121例,中年组(46～60岁年龄段)18例。术前病情分级:中度57例(37.50%),重度95例(62.50%)。伴足底多汗127例(83.55%),伴腋窝多汗101例(66.45%)。42例伴不同程度手部皮肤疾患,包括汗疱疹28例(18.42%),蜕皮24例(15.79%),皲裂11例(7.24%)。全部患者术后手掌多汗症状消失,双手转为干爽温暖状;152例术后随访1～45个月,平均25.4月,85例回信,54例电话随访,7例门诊随访,失访6例,随访率96.05%。
1.中度组57例,治愈57例,有效率100%,复发0例;重度组89例,治愈89例,有效率100%,复发0例。伴足底多汗者127例,足汗症状缓解率67.72%(86/127);伴腋汗增多者101例,腋汗症状缓解率82.18%(83/101)。
2.转移性多汗
①少年组术后转移性多汗发生率为30.00%(3/10),青年组为28.81%(34/118),中年组为27.78%(5/18)。各组发生率比较,差异不具有显著性(P﹥0.05)。
②男性组术后转移性多汗发生率为29.69%(19/64),女性组为28.05%(23/82)。两组发生率比较,差异不具有显著性(P﹥0.05)。
③中度组术后转移性多汗发生率为17.54%(10/57),重度组为35.96%(32/89)。两组发生率比较,差异具有显著性(P﹤0.05)。
④中度组术后转移性多汗10例,其中半年内自愈者5例,自愈率为50.00%(5/10);一年内自愈者共7例,自愈率为70.00%(7/10);一年半内自愈者共8例,自愈率为80.00%(8/10)。重度组术后转移性多汗32例,其中半年内自愈者11例,自愈率为34.38%(11/32);一年内自愈者共16例,自愈率为50.00%(16/32);一年半内自愈者共22例,自愈率为68.75%(22/32)。同一时间段两组自愈率相比较,差异均不具有显著性(P>0.05)。
3.中度组合并手部皮肤疾患者16例,术后手部皮肤疾患消失15例,治愈率93.75%;重度组合并手部皮肤疾患者26例,术后手部皮肤疾患消失15例,治愈率57.69%。两组手部皮肤疾患治愈率相比,差异具有显著性(P﹤0.05)。
4.全组患者术后无血气胸,霍纳氏综合症等并发症,少数患者诉术后胸部隐痛,持续时间一般未超过两周。
结论:1.手术有效率100%,无一例复发。2.手术后疗效与术前病情分级无相关性,均可完全治愈。大部分患者足汗及腋汗术后可以缓解。3.术后转移性多汗的发生率与患者年龄及性别无相关性,而与术前病情分级有相关,重度组术后转移性多汗发生率高于中度组。术后转移性多汗的自愈时间和自愈率与术前病情分级无相关。大部分转移性多汗可以自愈。4.术前病情分级与伴随手部皮肤疾患术后恢复情况有相关,重度组皮肤疾患治愈率低于中度组。总之,胸腔镜下T_2～T_4交感神经链切断术是治疗手汗症有效,安全,微创的方法。
Objective: To investigate the outcomes, complications and preservation about ETS for PH.
Methods: Analyzing the results and complications about the 152 cases, who were received ETS for treating PH from Jan.2003 to Sep. , and were followed up.
Results: In 152 patiens after ETS, aged 13-60 years and 27.88 years on average; 13 juvenile (aged 13~17years), 121 youth (aged 18~45years), 18 middle age (aged 46~60years); 66 males, 86 females; 57 midrange, 95 serious-range; 127 FH, 101 AH. 42 of them went with disease on the hands, include 28 herpes, 24 exuviae, 11 rhagades. All of their hands became dry and warm after operation. 146 patiens were followed-up for 1 to 45 months, and 25.4 months on average: 7 of them were clincchekups, 54 of them were followed by phone, 85 of them by mail. The follow-up rate is 96.05%. The total results: No recurrence, hemopneumothorax, Horner’s syndrome and other serious complications.
The cure rate that for midrange and serious-range PH case were 100% (57/57, 89/89). That for FH and AH were 67.72%(86/127) and 82.18%(83/101) respectively.
The incidence of CH in patiens with different ages is 30.00%(juvenile, 3/10)、28.81%(youth, 34/118) and 27.78%(middle age, 5/18). (P>0.05). The incidence of CH in patiens with different sex is 29.69%(males, 19/64) vs 28.05%(females, 23/82). (P>0.05). The incidence of CH in patiens with different range is 17.54%(midrange, 10/57) vs 35.96%(serious-range, 32/89). (P﹤0.05). In 57 patiens with midrange PH, 10 CH. 5 of them were self-cure in half a year, 7 in one year, 8 in one and a half year; in 89 patiens with serious-range PH, 32 CH, 11 of them were self-cure in half a year, 16 in one year, 22 in one and a half year. (P>0.05).
In 16 patiens midrange PH with disease on hands, 15 curing; in 26 patiens serious-range PH with disease on hands, 15 curing. Significantly different.
A few of them complained pain on chest, few of that last for two weeks.
Conclusion: 1.The curing rate is 100%, none recurred. 2. There are no association among the outcome and the range of PH. Most of the FH and AH can be cured following the curing of PH. 3. There are no association among the incidence of CH and the age or sex. There are some association among the range of PH and the incidence of CH , but no association among the range of PH and the self-cure time. The serious-range has the higher rate of CH than midrange. 4. There are some association among the range of PH and the cure about disease on hands. The serious-range has the lower rate of cruing than midrange. Above all, It is effective, safer and mini-trauma that ETS for treating PH.
引文
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[24] Lin CC. A new method of thoracoscopic sympathectomy for palmars hyperhidrosis[J]. Surg Endos, 1990, 4: 224-226
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[26] 杨劼,王俊,谭家驹 等.胸交感神经链切断术治疗手汗症手术方法的改进[J].中华心血管外科杂志, 2005, 12(21): 377-378
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[28] Byrne J, Walsh TN, Hederman WP. Endoscopic transthoracic electrocautery of the sympathetic chain for palm and axillary hyperhidrosis[J]. Br J Sury, 1990, 77: 1046-1049
[29] Riolo J, Gumucio CA, Young AE, et al. Surgical management of palmar hyperhidrosis[J]. South Med J, 1990, 83: 1138-1143
[30] Shelly WB, Hurley HJ. Studies on topical antiperspirant control of axillary hyperhidrosis[J]. Acta Derm Venereol, 1975, 55: 241-260
[31] 刘彦国,杨劼,王俊 等.T3, T4 交感神经链切断术治疗手汗症的比较[J].中华医学杂志, 2006, 9(5): 2318-2319
[32] 周志冰,严志昆,朱理 等.胸腔镜下胸交感神经切断术治疗手汗症 110 例[J].中国胸心血管外科临床杂志, 2003, 5(10): 134-135
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[34] 严松龄,姜杰,黄孕西 等.胸交感神经节切除数目与手汗疗效关系探讨[J].腹腔镜外科杂志, 2004, 9(9): 189-190
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[36] Lin TS. Video-assisted thoracoscopic sympsthicotomy for primary palmar hyperhidrosis: analysis of 42 cases[J]. Ann Thorac Surg, 2001, 72: 895-898
[37] 林敏,涂远荣,李旭 等.胸腔镜下胸交感神经干切断术治疗手汗症 200 例远近期随访报告[J].中华微创外科杂志, 2005, 12(5): 993-994
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[39] Lin TS, Fang HY. Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis with emphasis on peroperative management[J]. Surg Neurol, 1999, 52: 453-457
[40] Lin CC, Wu HH. Endoscopic T4-sympathetic block by claming(ESB4) in treatment of hyperhidrosis palmaris et axillaries-experiencesc of 165 cases[J]. Ann Chir Gyn, 2001, 90: 167-169
[41] 林敏,涂远荣,李旭 等.不同节段胸交感神经干切断术治疗手汗症的疗效比较[J]. 中华医学杂志, 2006, 9(5): 2315-2316
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[46] Gossot D, Kabiri H, Caliandro R, et al. Early complication of thoracic endoscopic sympathectomy: a prospective study of 940 procedures[J]. Ann Thorac Surg, 2001, 71: 1116-1119
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[51] Reisfeld R, Nguyen R. Endoscopic thoracic sympathectomy for hyperhidrosis: experience with both cauterization and clamping methods[J]. Surg Laparosc Endosc Percutan Tech, 2002,12: 255-267
[52] 郭绍红,王晶晶,严金 等.阻断胸交感神经干治疗头面部多汗 58 例随访报告[J]. 腹腔镜外科杂志, 2005, 21: 377-378
[2]高明见.儿童手汗症的微侵袭疗法[J].中国微侵袭神经外科杂志,2002,4:246-248
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[10]涂远荣,李旭,林敏 等.胸腔镜下胸交感神经干切断术的临床研究(附 200 例报告)[J].中国微创外科杂志,2005,12(5):993-994
[11]杨劼,王俊,谭家驹 等.胸交感神经链切断术治疗手汗症手术方法的改进[J].中华心血管外科杂志, 2005, l2(21):377-378
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[15]刘彦国,杨劼,王俊 等.T3, T4 交感神经链切断术治疗手汗症的比较[J].中华医学杂志, 2006, 9(5): 2318-2319
[16]周志冰,严志昆,朱理 等.胸腔镜下胸交感神经切断术治疗手汗症 110 例[J].中国胸心血管外科临床杂志, 2003, 5(10):134-135
[17]Lin TS,Huang LC, Wang NP,et al. Video-assisted thoracoscopic T2 sympathetic block by cilpping for palmar hyperhidrosis : analysis of 52 cases[J].J Laparoendosc Adv Surg Tech A, 2001, 11: 59-62
[18]严松龄,姜杰,黄孕西 等.胸交感神经节切除数目与手汗疗效关系探讨[J].腹腔镜外科杂志,2004,9(9):189-190
[19]Skelly W B, Florence R. Compensatory hyperhidrosis after sympathectomy[J].N engl J Med,1960,263:1056-1058
[20]Lin TS. Video-assisted thoracoscopic sympsthicotomy for primary palmar hyperhidrosis: analysis of 42 cases[J].Ann Thorac Surg,2001,72:895-898
[21]林敏,涂远荣,李旭 等.胸腔镜下胸交感神经干切断术治疗手汗症 200 例远近期随访报告[J].中华微创外科杂志,2005,12(5):993-994
[22]Lin TS,Kuo Sj, Chou MC. Uniportal endoscopic thoracic sympathectomy for treatment of palmar and axillary hyperhidrosis:analysis of 2000 cases[J]. Neurosurgery, 2002, 51(5 suppl):s84-s87
[23]Lin TS, Fang HY. Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis with emphasis on peroperative management[J].Surg Neurol, 1999,52:453-457
[24]Lin CC, Wu HH. Endoscopic T4-sympathetic block by claming(ESB4) in treatment of hyperhidrosis palmaris et axillaries-experiencesc of 165 cases[J].Ann Chir Gyn, 2001, 90: 167-169
[25]林敏,涂远荣,李旭 等.不同节段胸交感神经干切断术治疗手汗症的疗效比较[J].中华医学杂志,2006,9(5):2315-2316
[26]傅成国,姜杰,康健乐.电视胸腔镜胸交感神经干切断术治疗手汗症 50 例[J].中华微创外科杂志,2006,9(6):657-658
[27]倪科伟,严志焜,朱理 等.胸交感神经钛夹阻断术预防手汗症患者术后代偿性多汗[J].浙江医学,2004,26(2):131-132
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[25] Skelley W B. Compansatory hyperhidrosis after sympathectomy[J]. N Engl J Med, 1960, 263: 1056-1058
[26] 杨劼,王俊,谭家驹 等.胸交感神经链切断术治疗手汗症手术方法的改进[J].中华心血管外科杂志, 2005, 12(21): 377-378
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[28] Byrne J, Walsh TN, Hederman WP. Endoscopic transthoracic electrocautery of the sympathetic chain for palm and axillary hyperhidrosis[J]. Br J Sury, 1990, 77: 1046-1049
[29] Riolo J, Gumucio CA, Young AE, et al. Surgical management of palmar hyperhidrosis[J]. South Med J, 1990, 83: 1138-1143
[30] Shelly WB, Hurley HJ. Studies on topical antiperspirant control of axillary hyperhidrosis[J]. Acta Derm Venereol, 1975, 55: 241-260
[31] 刘彦国,杨劼,王俊 等.T3, T4 交感神经链切断术治疗手汗症的比较[J].中华医学杂志, 2006, 9(5): 2318-2319
[32] 周志冰,严志昆,朱理 等.胸腔镜下胸交感神经切断术治疗手汗症 110 例[J].中国胸心血管外科临床杂志, 2003, 5(10): 134-135
[33] Lin TS, Huang LC, Wang NP, et al. Video-assisted thoracoscopic T2 sympathetic block by cilpping for palmar hyperhidrosis : analysis of 52 cases[J]. J Laparoendosc Adv Surg Tech A, 2001, 11: 59-62
[34] 严松龄,姜杰,黄孕西 等.胸交感神经节切除数目与手汗疗效关系探讨[J].腹腔镜外科杂志, 2004, 9(9): 189-190
[35] Skelly W B, Florence R. Compensatory hyperhidrosis after sympathectomy[J]. N engl J Med, 1960, 263: 1056-1058
[36] Lin TS. Video-assisted thoracoscopic sympsthicotomy for primary palmar hyperhidrosis: analysis of 42 cases[J]. Ann Thorac Surg, 2001, 72: 895-898
[37] 林敏,涂远荣,李旭 等.胸腔镜下胸交感神经干切断术治疗手汗症 200 例远近期随访报告[J].中华微创外科杂志, 2005, 12(5): 993-994
[38] Lin TS, Kuo Sj, Chou MC. Uniportal endoscopic thoracic sympathectomy for treatment of palmar and axillary hyperhidrosis:analysis of 2000 cases[J]. Neurosurgery, 2002, 51(5 suppl): s84-s87
[39] Lin TS, Fang HY. Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis with emphasis on peroperative management[J]. Surg Neurol, 1999, 52: 453-457
[40] Lin CC, Wu HH. Endoscopic T4-sympathetic block by claming(ESB4) in treatment of hyperhidrosis palmaris et axillaries-experiencesc of 165 cases[J]. Ann Chir Gyn, 2001, 90: 167-169
[41] 林敏,涂远荣,李旭 等.不同节段胸交感神经干切断术治疗手汗症的疗效比较[J]. 中华医学杂志, 2006, 9(5): 2315-2316
[42] 傅成国,姜杰,康健乐.电视胸腔镜胸交感神经干切断术治疗手汗症 50 例[J].中华微创外科杂志, 2006, 9(6): 657-658
[43] Kurchin A, Mozes M, Walden R, et al. Phantom sweating[M]. Angiology, 1983, 28: 799-802
[44] Bloor K. Gustatory sweating and other responsea after cervicothoracic sympathectomy[J]. Brain, 1980, 92: 137-146
[45] Cameron AE. Complications or endoscopic sympathecomy[J]. Eur J Surg Suppl,1998, 580:33-35
[46] Gossot D, Kabiri H, Caliandro R, et al. Early complication of thoracic endoscopic sympathectomy: a prospective study of 940 procedures[J]. Ann Thorac Surg, 2001, 71: 1116-1119
[47] Lange JF. Enferior brachial plexus injury during thoracoscopic sympathectomy[J]. Surg endosc, 1995, 9: 64-66
[48] Denny-Brown D, Brenner C. Lesion in peripheral nerve resulting from compression by spring clip[J]. Arch Neurol Psychiatry, 1994, 52: 1
[49] 倪科伟,严志焜,朱理 等.胸交感神经钛夹阻断术预防手汗症患者术后代偿性多汗[J].浙江医学, 2004, 26(2): 131-132
[50] Lee DY, Hong YJ, Shin HK. Thoracoscopic sympathetic surgery for hyperhidrosis[J]. Yonsei Med J, 1999, 40:589-595
[51] Reisfeld R, Nguyen R. Endoscopic thoracic sympathectomy for hyperhidrosis: experience with both cauterization and clamping methods[J]. Surg Laparosc Endosc Percutan Tech, 2002,12: 255-267
[52] 郭绍红,王晶晶,严金 等.阻断胸交感神经干治疗头面部多汗 58 例随访报告[J]. 腹腔镜外科杂志, 2005, 21: 377-378