Thoracoscopic sympathectomy for palmar hyperhidrosis: a meta-analysis of studies published during the past decade / 中华胸心血管外科杂志

ABSTRACT

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.