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@#Objective To investigate the clinical safety and feasibility of thoracic sympathectomy in the treatment of palmar hyperhidrosis based on ambulatory surgery. Methods A retrospective analysis of 74 patients who underwent thoracoscopic sympathectomy in the Department of Thoracic Surgery of the First People's Hospital of Yunnan Province from January 2017 to April 2021 was performed, including 35 males and 39 females aged 12-38 (21.32±4.13) years. Patients were divided into two groups according to different treatments. There were 34 patients in a control group (adopting traditional surgery), and 40 patients in an observation group (adopting ambulatory surgery). The clinical effects of the two groups were compared. Results No massive bleeding, conversion to thoracotomy, postoperative pneumo-thorax or severe pneumonia occured in all patients. Univariate analysis of intraoperative indexes showed that the two groups had no statistical difference in total hospitalization cost, operation time, anesthesia time or postoperative waiting time (P>0.05). The amount of intraoperative blood loss in the observation group was less than that in the control group (P<0.05). The time of postoperative out of bed and recovery of walking capacity and the incidence of electrolyte disturbance in the observation group were shorter or lower than those in the control group (P<0.05). There was no statistical difference in white blood count, neutrophils count or postoperative 24 h pulse oxygen saturation fluctuation peak between the two groups (P>0.05). Conclusion Based on the optimized diagnosis and treatment model, thoraco-scopic sympathectomy with laryngeal mask airway which is performed during ambulatory surgery, is feasible and worth popularizing in thoracic surgery.
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@#Objective To investigate the safety and feasibility of day surgery for patients with palmar hyperhidrosis based on the principles of enhanced recovery after surgery (ERAS). Methods We retrospectively reviewed the medical records of consecutive patients who underwent endoscopic thoracic sympathicotomy (ETS) in the First Affiliated Hospital of Xi'an Jiaotong University from March 2020 to December 2021. Patients were divided into a day surgery group and a conventional group according to their perioperative management methods. The patients in the day surgery group underwent an optimized perioperative procedure under the guidance of ERAS, and were ventilated with a laryngeal or face mask during the operation. The patients in the conventional group completed the preoperative examination, operation and postoperative observation according to the conventional procedures, and were intubated with a single-lumen endotracheal tube. The demographic characteristics, operation time, hospital stay, postoperative complications, and hospitalization cost were compared between the two groups. Results Finally 172 patients were collected, including 90 males and 82 females, with an average age of 25.97±7.43 years. There were 86 patients in each group. All patients ceased suffering from palmar sweating after surgery. No patient experienced massive bleeding or conversion to thoracotomy. There was no statistical difference in operation time between the two groups (P=0.534). Patients in the day surgery group were discharged within 24 hours. The average hospital stay in the conventional group was 2.09±0.41 days. Incidence of postoperative respiratory complications, and the hospitalization cost of the day surgery group were significantly lower than those of the conventional group (P<0.001). The satisfaction rate in both groups was greater than 95%. Conclusion Day surgery for patients with palmar hyperhidrosis based on the principles of ERAS is safe and feasible, which can reduce postoperative complications, shorten the length of hospital stay and save the cost of hospitalization.
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Objective:To investigate the anatomical variation of the T3 sympathetic ganglia and its relationship with surgical outcomes in primary palmar hyperhidrosis.Methods:A total of 86 patients with primary palmar hyperhidrosiswho underwent R4 sympathicotomy from November 2017 to September 2018 were prospectively enrolled. The anatomical variation of T3 sympathetic ganglia was observed by fluorescence thoracoscopy. The therapeutic effect and side effect were followed up after operation.The relationship between T3 anatomical variation and postoperative effect was analyzed.Results:82.6% of T3 ganglion had no anatomic variation, 17.4% of T3 ganglion shifted down to the surface of the fourth rib or intercostal space. After 1 month of follow-up, the therapeutic effect was: overly dry 2.1%, dry 39.4%, mild moist 57.0%, moist 1.4% innormalside, and 13.3%, 53.3%, 33.3%, 0 in the variation side respectively. Mann- Whitney U test showed statistically significant difference between the two groups( P=0.004). After 1 year of follow-up, the effect was 0, 36.5%, 56.9%, 6.6% in normal side, and 0, 33.3%, 63.0%, 3.7% in the variation side respectively. There was no significant difference between the two groups by Mann- Whitney U test( P=0.869). Conclusion:Fluorescence thoracoscopy showed that the variation rate of the position of T3 sympathetic ganglion was 17.4%. Postoperatively, patients with the downshift variation of T3 sympathetic ganglion have drier hands in short-term follow-up.
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@#Objective To explore the safety, feasibility and superiority of tubeless video-assisted thoracoscopy in the treatment of primary palmar hyperhidrosis (PPH). Methods The clinical data of 46 patients with palmar hyperhidrosis treated by thoracoscopy in the Department of Thoracic Surgery of the First Hospital of Lanzhou University from March 2017 to September 2020 were retrospectively analyzed. Among them, 22 received tubeless video-assisted thoracoscopic surgery, and were divided into a tubeless group, including 10 males and 12 females with an average age of 24.3±6.4 years; 24 received conventional thoracoscopic surgery, and were divided into a control group, including 13 males and 11 females with an average age of 23.5±4.8 years. The operation status, anesthesia effect and postoperative complications of the two groups were compared. Results Forty-six patients successfully completed the operation with the assistance of thoracoscopy. There was no intraoperative transfer to thoracotomy, or intraoperative transfer to tracheal intubation in the tubeless group. Anesthetic recovery time (14.4±1.6 min vs. 20.1±1.8 min, P=0.000), time to get out of bed on the first postoperative day (3.1±0.6 h vs. 1.6±0.4 h, P=0.000), visual analogue score for postoperative pain (1.4±0.6 points vs. 3.4±1.1 points, P=0.000), postoperative hospital stay (1.7±0.5 d vs. 2.8±0.6 d, P=0.000), postoperative satisfaction rate of patients (95.5% vs. 66.7%, P=0.037) in the tubeless group were shorter or better than those in the control group. There was no statistical difference in age, gender, smoking history, palmar hyperhidrosis classification, palms or other associated parts, the total time of bilateral surgery, intraoperative blood loss, postoperative complications, or compensatory hyperhidrosis (mild) between the two groups (P>0.05). Conclusion Compared with traditional thoracoscopic surgery for PPH, tubeless video-assisted thoracoscopic surgery for PPH has the advantages of safety, reliability, light pain and quick recovery, in line with the concept of accelerated rehabilitation surgery.
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@#Objective To explore the clinical effect of tubeless 3 mm ultra-fine thoracoscope combined with needle electrocoagulation hook thoracic sympathicotomy in the treatment of primary palmar hyperhidrosis. Methods The clinical data of 77 patients with primary palmar hyperhidrosis who underwent surgery in the First Hospital of Lanzhou University from September 2017 to July 2021 were retrospectively analyzed, including 50 males and 27 females, with an average age of 23.60±5.60 years. A total of 36 patients were treated with tubeless 3 mm ultra-fine thoracoscopic electrocoagulation hook thoracic sympathicotomy (an observation group), and 41 patients were treated with conventional thoracoscopic thoracic sympathicotomy (a control group). The baseline data, perioperative data and the results of 12 hours after operation were compared between the two groups. Results All the 77 patients completed the operation successfully, no conversion to thoracotomy, no intraoperative bleeding, and no conversion to endotracheal intubation in the observation group. In the observation group, the time of anesthesia before operation [19.00 (17.00, 23.75) min vs. 25.00 (21.00, 27.00) min, P=0.001] and postoperative hospital stay [2.00 (1.00, 2.00) d vs. 2.00 (1.00, 3.00) d, P=0.012] were shorter than those in the control group. The operation time [22.50 (21.00, 25.75) min vs. 26.00 (23.50, 28.50) min, P=0.001], intraoperative blood loss [5.00 (2.25, 5.00) mL vs. 6.00 (5.00, 10.00) mL, P=0.003], postoperative pain index [2.00 (1.00, 2.00) vs. 3.00 (2.00, 3.00), P=0.001], hospitalization cost (14 246.58±879.28 yuan vs. 15 085.90±827.15 yuan, P<0.001) and postoperative inflammation index: white blood cell count [(12.96±2.32)×109/L vs. (14.47±2.05)×109/L, P=0.003], percentage of neutrophils (76.31%±5.40% vs. 79.97%±7.12%, P=0.014) were significantly lower or less than those in the control group. There was no significant difference in the incidence of major postoperative complications or adverse consequences between the two groups (P>0.05). In the evaluation of 12 hours after operation, the time of getting out of bed [2.00 (1.00, 2.00) h vs. 2.00 (2.00, 3.00) h, P=0.017], the time of drinking water after operation [1.50 (1.00, 2.00) h vs. 2.00 (1.00, 3.00) h, P=0.005], and the heart rate (80.25±14.42 bpm vs. 91.07±15.08 bpm, P=0.002), the incidence of dizziness, nausea and other uncomfortable symptoms (5.6% vs. 25.0%, P=0.040) at 12 hours after operation were shorter or lower than those in the control group. There was no significant difference in blood oxygen saturation (non-inhaled oxygen state) 12 hours after the operation between the two groups [97.00% (95.25%, 98.00%) vs. 97.00% (96.00%, 98.00%), P=0.763]. Conclusion Compared with conventional thoracoscopic thoracic sympathicotomy, tubeless 3 mm ultra-fine thoracoscopic electrocoagulation hook thoracic sympathicotomy can significantly shorten the operation time, reduce postoperative pain and promote postoperative recovery, in line with the concept of accelerated rehabilitation surgery and minimally invasive surgery, and is worth popularizing in clinical practice.
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@#Objective To assess the feasibility and safety of ultra-micro 5 mm single-port endoscopic thoracic sympathicotomy in selected patients with primary palmar hyperhidrosis. Methods From March 1, 2018 to February 1, 2021, 90 patients with primary palmar hyperhidrosis who underwent ultra-micro 5 mm single-port endoscopic thoracic sympathicotomy at the Thoracic Surgery Department of the University of Hong Kong-Shenzhen Hospital. There were 47 males and 43 females, with a median age of 26.0 (22.0, 31.0) years. During the operation, T3 and/or T4 thoracic sympathetic nerve chain was transected using an ultra-micro 5 mm single-port incision near the areola or under the axilla. The surgical data of the patients were retrospectively reviewed and analyzed. Results All patients successfully completed the operation without major bleeding during the operation and no conversion to thoracotomy. There was no death or serious complication during the perioperative period. The operation time was 43.0 (23.0, 60.0) min, and the intraoperative blood loss was 2.0 (1.0, 2.0) mL. In the perioperative period, only one patient needed a tiny chest tube indwelling. The symptoms of hyperhidrosis on the hands all disappeared after the operation. The pain score on the postoperative day was 2.0 (2.0, 2.0) points. The hospital stay after surgery was 1.0 (1.0, 1.0) d. In the first month after the operation, the symptoms of hyperhidrosis on the hands were significantly relieved compared with those before the operation. The surgical incisions healed well, the wounds were concealed, and there was no wound infection or poor healing. The patients' satisfaction with the surgical incisions was 100.0%. After the operation, 14 (15.6%) patients had mild compensatory hyperhidrosis, 5 (5.6%) patients had moderate compensatory hyperhidrosis, and no patient had severe compensatory hyperhidrosis. Overall satisfaction rate was 94.0%. Conclusion The clinical application of ultra-micro 5 mm single-port endoscopic thoracic sympathicotomy in selected patients with primary palmar hyperhidrosis is safe and feasible. The surgical wound is extremely small and hidden, the operation time is short, the pain is very slight, and the clinical outcome is good. It can fully meet the patients' pursuit of beauty.
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@#Objective To evaluate the quality of life (QOL) in patients with primary palmar hyperhidrosis (PPH) after endoscopic thoracic sympathicotomy (ETS) and analyze the influencing factors. Methods A total of 243 patients (118 males and 125 females, with an average age of 21.99±6.31 years) with PPH who were successfully treated with ETS (only T3 level thoracic sympathicotomy) in our hospital from January 2017 to January 2018 were enrolled, and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) was used to assess the QOL scores before and after ETS. By establishing a linear regression model of gender, age, body mass index, compensatory hyperhidrosis (CH) and palm dryness, and the relationship between the changes of the QOL scores and various factors was studied. Results The total QOL score after surgery was higher than that before surgery (63.01±4.58 vs. 48.11±1.95, P<0.05). Compared with the negative group of CH, the QOL score decreased by 4.662 in the postoperative CH patients. For every grade of CH severity increasing, the QOL score decreased by 3.449. Compared with the negative group, the QOL scores decreased by 1.804 and 2.400 respectively for every grade of CH severity increasing in the patients with postoperative chest and back CH. Conclusion ETS can not only improve the symptoms of abnormal palmar hyperhidrosis, but also significantly improve the QOL. Severe chest and back CH is an important factor affecting the QOL of patients.
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@#This guideline systematically reviewed and summarized the 20 years' clinical and basic research experience of minimally invasive treatment of palmar hyperhidrosis (PH) in China, and discussed the hot and difficult issues of minimally invasive treatment of PH. We have formed a new consensus of PH in terms of its definition, clinical manifestations, diagnostic criteria and classification, surgical indications and contraindications, surgical procedures and management of complications, especially in the area of postoperative compensatory hyperhidrosis (CH). This guideline confirmed that endoscopic thoracic sympathicotomy (ETS) was the most effective treatment for PH and that CH was the most common side effect. In order to reduce the incidence of CH, eliminate patient's distress and improve patient's satisfaction, the guideline emphasized that the keys to prevent CH were to pay attention to pre-operative interview, communicate with patients, select patients carefully, avoid the enlargement of operative indication and optimize operative procedure. This guideline also introduced the advantages and disadvantages of various methods to reduce the incidence of CH. We provided this authoritative guidance document in order to avoid the surgical risk, strengthen the perioperative management and improve the sugery effect.
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@#Objective To analyze the safety and feasibility of the adhesion dissection in transaxillary uniportal thoracoscopy for palmar hyperhidrosis. Methods Data of 168 patients, including 77 males and 91 females with an average age of 14 - 41 (24.3±5.4) years, who received transaxillary uniportal video-assisted thoracoscopic surgery (VATS) for palmar hyperhidrosis from January 2015 to July 2018 were retrospectively analyzed. Severe adhesion was found in 4 patients and mild adhesion was found in 12 patients. Artificial pneumothorax was used to help dissect adhesion. Preoperative CT scan could help locate the rib according to the relative position to azygos vein or aotic arch. Results All of 168 patients were successfully completed with transaxillary uniportal VATS. Then chest tubes were put in the 4 severe adhesion patients. The tube was removed from one patient after 11 days because of air leak, and from the other three patients on the next day. The other 164 patients with or without adhesion were discharged from hospital on the operation day or the next day. Conclusion Adhesion dissection in transaxillary uniportal VATS for palmar hyperhidrosis is safe and feasibile.
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@#Objective To investigate the prevalence and related factors of primary palmar hyperhidrosis in adolescents in Yangzhou. Methods On-site questionnaire survey was performed on students selected by cluster random sampling from the two colleges and two high or middle schools, with each class as a unit. Data were collected through the questionnaire to make the diagnosis and severity grading. Results A total of 3 487 copies of the questionnaire were distributed in the survey and 3 299 were finished, among which 3 083 were effective with an effective rate of 88.41%. Among them, 1 358 respondents were males and 1 725 were females; 933 were middle school students, 809 high school students, and the remaining 1 341 college students. According to the diagnostic criteria, 104 respondents were diagnosed with palmar hyperhidrosis with an overall prevalence of 3.37%. There were 60 (4.41%) males and 44 (2.55%) females. Although the prevalence of palmar hyperhidrosis in males was higher than that of females (χ2=8.130，P<0.05), severe palmar hyperhidrosis was more often to be observed in females than in males, and females were also more likely to have hyperhidrosis in other parts of the body. In addition, the age of the first onset of the disease was mainly 10 to 20 years old and 36.54% of the patients had a family history. Conclusion The prevalence of palmar hyperhidrosis in adolescents in Yangzhou was 3.37%, and there is a significant difference in the gender. The palmar hyperhidros is often accompanied by hyperhidrosis symptoms of other parts of body, and the disease shows an obvious genetic predisposition.
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[Objective]Research on treatment based on syndrome differentiation of palmar hyperhidrosis(PH), for the purpose of systematically and comprehensively understanding PH, and to improve clinical curative effect. [Methods]The pathological basis, clinical manifestation and therapeutic principle and methods are systematically summarized.[Result]PH is relevant to the cold, heat, deficiency and excess of taste, disorder of Qi and blood of heart, and the block of damp and hot. Exuberant heat in Yangming, deficiency cold of spleen and stomach, and food stagnation can lead to PH. Malnutrition of heart spirit and dysfunction of heart caused by insufficiency of heart yin also contribute to PH. Another factor is the block of damp-heart. The treatment for PH caused by exuberant heat in Yangming is Baihu Decoction or Chengqi Decoctions. PH caused by deficiency cold of spleen and stomach can be cured by Lizhong Decoction. The treatment for PH caused by food stagnation is Baohe Wan. Insufficiency of heart yin and disharmony between Ying and Wei need to nourish blood for tranquillization and harmonize Ying and Wei. The block of damp or damp-heat leading to PH need drug resolving dampness with aromatics or clearing heat and promoting diuresis for cure. [Conclusion]PH has a complex pathogenesis, which needs treatment based on syndrome differentiation.
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[Objective]Research on treatment based on syndrome differentiation of palmar hyperhidrosis(PH), for the purpose of systematically and comprehensively understanding PH, and to improve clinical curative effect. [Methods]The pathological basis, clinical manifestation and therapeutic principle and methods are systematically summarized.[Result]PH is relevant to the cold, heat, deficiency and excess of taste, disorder of Qi and blood of heart, and the block of damp and hot. Exuberant heat in Yangming, deficiency cold of spleen and stomach, and food stagnation can lead to PH. Malnutrition of heart spirit and dysfunction of heart caused by insufficiency of heart yin also contribute to PH. Another factor is the block of damp-heart. The treatment for PH caused by exuberant heat in Yangming is Baihu Decoction or Chengqi Decoctions. PH caused by deficiency cold of spleen and stomach can be cured by Lizhong Decoction. The treatment for PH caused by food stagnation is Baohe Wan. Insufficiency of heart yin and disharmony between Ying and Wei need to nourish blood for tranquillization and harmonize Ying and Wei. The block of damp or damp-heat leading to PH need drug resolving dampness with aromatics or clearing heat and promoting diuresis for cure. [Conclusion]PH has a complex pathogenesis, which needs treatment based on syndrome differentiation.
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Objective To investigate palmar hyperhidrosis (PH) and the effects on mental health in a military command.Methods 26 392 soldiers were enrolled in this study by stratified-cluster random sampling.Each was required to complete a self-administered questionnaire regarding PH.The soldiers were assessed with symptom checklist-90 (SCL-90) and the factor scores were compared with army norm and civilian norm.Results A total of 25680 subjects fulfilled the questionnaires,and the response rate was 97.3％.The prevalence of PH in the survey sample was 2.66％ and the mild,moderate,and severe PH were 1.49％,0.83％,and 0.34％,respectively.The total mean score of SCL-90 in soldiers with PH (1.72±0.54) was higher than those none PH soldiers (1.65±0.58),civilian norm (1.49±0.41) and military norm (1.63±0.30).Multiple regression analysis showed that age,level of education and severity of PH were important factors for mental health of soldiers with PH (P＜0.05).Conclusion PH is more common in the military,which affect the mental health.The health service departments should pay attention to the treatment and psychological intervention of PH.
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Objective To compare the efficacy of transumbilical-ultrafine gastroscope sympathectomy for severe palmar hyperhidrosis using two distinct levels of T3 and T4.Methods A total of 84 cases with severe primary hyperhidrosis were randomly allocated to undergo either T3 sympathectomy treatment (T3 group, n =42) or T4 sympathectomy treatment (T4 group, n =42) with no difference between the two groups.The operation time, postoperative hospital stay, patient's hands hyperhidrosis, axillary hyperhidrosis,complications were recorded at follow-up in 1,3,6,12 months.Results Operation on 84 patients were successful with mean operative time of T3 group being 55.02 ± 10.61 min and T4 group being 55.36 ± 10.51 min(P ＞ 0.05).The mean postoperative hospital stay were both 1.5 days.Patients were followed up for diaphragmatic hernia, umbilical hernia, Horner's syndrome and other serious complications for 12 months.No postoperative recurrence of palmar hyperhidrosis, severe compensatory sweating occurred in either group.The number of improved patients in T3 group's palmar hyperhidrosis,axillary hyperhidrosis, and foot hyperhidrosis were :42/42 cases, 10/16 cases, 21/29 cases, while those in T4 group were: 42/42 cases,16/17 cases 18/28 cases.Axillary hyperhidrosis improved to a larger extent in T4 group than in T3 group (P ＜0.05).There were 16(15 mild and 1 moderate)compensatory sweating in T3 group and 7(6 mild and 1 moderate) compensatory sweating in T4 group (P ＜ 0.05).Conclusion T3 and T4 thoracic sympathectomy using transumbilical-ultrafine gastroscope for primary palmar hyperhidrosis are safe, effective, and feasible.T4 sympathectomy is more effective in improving axillary hyperhidrosis than T3 and shows lower occurrence of postoperative compensatory hyperhidrosis.
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Objective To evaluate video-assisted thoracoscopic sympathectomy(VTS) for the treatment of palmar hyperhidrosis(PH),and to analyze curative efficacies for surgeries on different sympathetic segments.Methods Medline search was done on PubMed and data of randomized controlled trials(RCTs) about comparisons of surgeries on different segments over the past decade were collected.According to the inclusion criterion,relevant articles were screened.Then we extracted data,assessed trail quality,and performed Meta-analysis by using RevMan 5.2 with postoperative compensatory hyperhidrosis(CH) as the main evaluation index.Results A total of 11 RCTs involving 1 413 patients were included,among which all patients underwent bilateral VTS.Ef cacious rates were similar between multiple and single ganglia sympathectomy(97.7％ vs 98.8％,P ＜0.01).However,single-ganglia group showed a lower risk of CH compared to multiple-ganglia group.Meta-analysis suggested that,in the subgroups of the single-ganglia VTS,no significant difference was found between T2/T3 and other segments in the risk of CH [T2 segment vs other segments,RR =1.11,95 ％ CI(0.99,1.24) ; T3 segment vs other segments,RR =0.99,95％ CI(0.89,1.11)].The risk of CH was significantly lower in T4 sympathectomy than in other segments [RR =0.67,95％ CI(0.57,0.79)].By comparison of T2,T3 and T4 sympathectomy,we found that low segment had a lower risk of CH than high segment[RR =0.75,95％ CI(0.68,0.84)].Conclusion Single-ganglia and low segment sympathectomy can significantly reduce the incidence of CH,and T4 is supposed to be the best segment for the treatment of PH.
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Objective To study the clinical effect of endoscopic thoracic sympathectomy at different segments on palmar hyperhidrosis and research the incidence of postoperative compensatory hyperhidrosis.Methods One hundred palmar hyperhidrosis patients who underwent endoscopic thoracic sympathectomy were divided into 2 groups according to treatment method,the patients in A group (46 cases) received T4 surgery,the patients in B group (54 cases) received T3-4 surgery.The success rate of postoperative,incidence of postoperative compensatory hyperhidrosis and postoperative satisfaction rate between the 2 groups were compared.Results The surgery of 2 groups were successful.There was no statistical difference in total effective rate between the 2 groups (P ＞ 0.05).The incidence of postoperative compensatory hyperhidrosis in A group was significantly lower than that in B group [4.3％ (2/46) vs.20.4％ (11/54)],the postoperative satisfaction rate was significantly higher than that in B group [93.5％(43/46) vs.79.6％ (43/54)],there were statistical differences (P ＜ 0.05).Conclusion Endoscopic thoracic sympathectomy T3-4 or T4 surgery is very effective and safe treatment of palmar hyperhidrosis,but T4 surgery has a lower incidence of postoperative compensatory hyperhidrosis.
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OBJECTIVE: To compare two surgical techniques (denervation levels) for sympathectomy using video-assisted thoracoscopy to treat palmar hyperhidrosis in the long-term. METHODS: From May 2003 to June 2006, 60 patients with palmar hyperhidrosis were prospectively randomized for video-assisted thoracoscopic sympathectomy at the T2 or T3 ganglion level. They were followed for a mean of 20 months and were evaluated regarding their degree of improvement of palmar hyperhidrosis, incidence and severity of compensatory hyperhidrosis and its evolution over time, and quality of life. RESULTS: Fifty-nine cases presented resolution of the palmar hyperhidrosis. One case of therapeutic failure occurred in the T3 group. Most of the patients presented an improvement in palmar hyperhidrosis, without any difference between the groups. Twenty months later, all patients in both groups presented some degree of compensatory hyperhidrosis but with less severity in the T3 group (p = 0.007). Compensatory hyperhidrosis developed in most patients during the first month after the operation, with incidence and severity that remained stable over time. An improvement in quality of life was seen starting from the first postoperative evaluation but without any difference between the groups. This improvement was maintained until the end of the follow-up. CONCLUSION: Both techniques were effective for treating palmar hyperhidrosis. The most frequent complication was compensatory hyperhidrosis, which presented stable incidence and severity over the study period. Sympathectomy at the T3 level presented compensatory hyperhidrosis with less severity. Nevertheless, the improvement in quality of life was similar between the groups.
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Femenino , Humanos , Masculino , Adulto Joven , Mano/cirugía , Hiperhidrosis/cirugía , Simpatectomía/métodos , Métodos Epidemiológicos , Hiperhidrosis/epidemiología , Hiperhidrosis/etiología , Calidad de Vida , Simpatectomía/efectos adversos , Cirugía Torácica Asistida por Video , Vértebras Torácicas , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
Thoracoscopic thoracic sympathectomy (TTS) is usually a safe and uncomplicated procedure for treating essential palmar hyperhidrosis. However, we report a case of cardiovascular collapse that developed in a healthy patient undergoing TTS. The surgeon performed the left sympathectomy without incident. However, scarcely had an incision been made in the skin of the right chest when the patient developed sinus bradycardia and sudden, severe hypotension. Pulseless ventricular tachycardia occurred immediately thereafter, which rapidly progressed to ventricular fibrillation and cardiovascular collapse. The patient required resuscitation with 200 J of direct current shock defibrillation along with an intravenous injection of epinephrine 1 mg. She recovered without sequelae. We believe the Bezold-Jarisch reflex was triggered by pooling of venous blood and surgical stimuli, and the patient developed cardiovascular collapse as a result.
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Humanos , Bradicardia , Epinefrina , Hiperhidrosis , Hipotensión , Inyecciones Intravenosas , Reflejo , Resucitación , Choque , Piel , Simpatectomía , Taquicardia Ventricular , Tórax , Fibrilación VentricularRESUMEN
OBJECTIVE: The purposes of this study were to evaluate the change of temperature before and after thoracic sympathectomy in patients with palmar hyperhidrosis and to find the usefulness of infrared thermography for the assessment of effects of thoracic sympathectomy. METHOD: The skin temperature was measured before, one day and 30 days after sympathectomy in 28 patients with palmar hyperhidrosis. Temperature was recorded on forehead, cheek, neck, axilla, umbilicus and 6 sites of each hand and foot by infrared thermography and thermometer. Patient's satisfaction with operation was assessed by 10 point scale. RESULTS: All patient who had undergone sympathectomy showed significantly decreased discomfort owing to hyperhidrosis by 10 point scale (p<0.05). The temperature significantly elevated on postoperative 1 day and 30 days on both palms as compared with preoperative state, bilaterally (p<0.05). There were no significant differences of sole temperatures among preoperative, postoperative 1 day and postoperative 30 days, bilaterally. CONCLUSION: We proved significant effect of thoracic sympathectomy to the patients with palmar hyperhidrosis objectively, and we also quantified the elevation of palm temperature after sympathectomy.
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Humanos , Axila , Mejilla , Pie , Frente , Mano , Hiperhidrosis , Cuello , Temperatura Cutánea , Piel , Simpatectomía , Termografía , Termómetros , OmbligoRESUMEN
Objective To explore the clinical effect of the improved operation of endoscopic thoracic sympathectomy(ETS)for treatment of palmar hyperhidrosis.Methods The improved operation of ETS was used to 105 patients with palmar hyperhidrosis.T3 sympathetic was blocked in 105 cases with palmar hyperhidrosis.Results Hand sweating disappeared and axillary sweating discreased significantly in all patients.No one had any serious complications such as bleeding and Horner Syndrome except for five patients with pneumothoraces.Compensatory sweating was found in 15 patients following up from 1~12 months after operation.Conclusion The improved operation of ETS is a simple,safe,effective and less complications procedures.