胸腔鏡治療手汗癥：先左側(cè)還是先右側(cè)？

周冰 梅富楊 孫高忠 許林海

胸腔鏡治療手汗癥：先左側(cè)還是先右側(cè)？

周冰 梅富楊 孫高忠 許林海

目的 探討左側(cè)或者右側(cè)先行胸腔鏡下行胸交感神經(jīng)切斷術(shù)（ETS）對血流動(dòng)力學(xué)及治療效果的影響。 方法 納入成功完成 ETS 治療手汗癥的 108 例患者，按隨機(jī)數(shù)字表法分為 L 組和 R 組，每組 54 例。L 組先行左側(cè) ETS，R 組先行右側(cè) ETS，分析比較兩組患者圍術(shù)期血流動(dòng)力學(xué)指標(biāo)變化情況，并通過電話問卷方式對患者進(jìn)行隨訪，通過患者生活質(zhì)量對比兩種手術(shù)方式的療效差異。 結(jié)果 所有患者手術(shù)順利，術(shù)后手汗癥均得到顯著改善，兩組患者圍術(shù)期血壓、心率、心電圖矯正 QT 間期（QTc）、心率變異性（HRV）各項(xiàng)指標(biāo)無統(tǒng)計(jì)學(xué)差異。平均隨訪（12±2）個(gè)月，隨訪過程中，兩組患者生活質(zhì)量評分比較無統(tǒng)計(jì)學(xué)差異，未發(fā)現(xiàn)手汗癥復(fù)發(fā)、嚴(yán)重心率失常、死亡的病例。 結(jié)論 胸腔鏡治療手汗癥是安全、有效、微創(chuàng)的方法，左側(cè)或右側(cè)先行手術(shù)對手術(shù)治療效果無顯著影響。

胸腔鏡 手汗癥 胸交感神經(jīng)切斷術(shù) 生活質(zhì)量

【 Abstract 】 Objective To investigate the sequence of performing bilateral endoscopic thoracic sympathectomy(ETS)in treatment of palmar hyperhidrosis. Methods One hundred and eight patients with palmar hyperhidrosis undergoing bilateral ETS in our hospital were enrolled in this study.Patients were randomly divided into two groups:54 patients received left ETS first, followed by the right(group L),and another 54 patients received right ETS first,followed by the left(n=54).The perioperative hemodynamic changes were compared between the two groups;and the clinic effects and the quality of life of patients were evaluated one year after the operation. Results The bilateral ETS were performed smoothly,and the clinical effects were satisfactory in both groups.There were no significant differences in perioperative blood pressure,heart rate,corrected Q waves and T waves interval(QTc)in ECG,and heart rate variability(HRV)between the two groups.The patients were followed up period for 12 ±2 months;no differences were found in quality of life between the two groups and also no disease relapse,severe arrhythmia and death were reported. Conclusion ETS is a safe,effective,minimally invasive treatment for palmar hyperhidrosis. The sequence of performing left or right ETS first makes no significant difference on the clinical outcomes.

【 Key words 】 Thoracoscopy Palmarhyperhidrosis Endoscopic thoracic sympathicotomy Quality of life

胸腔鏡下行胸交感神經(jīng)切斷術(shù)（endoscopic thoracic sympathicotomy，ETS） 是微創(chuàng)治療手汗癥的唯一有效微創(chuàng)手術(shù)方法[1]。2011 年中華胸心血管外科雜志上刊發(fā)了《中國手汗癥微創(chuàng)治療專家共識》，為 ETS 的廣泛應(yīng)用及治療標(biāo)準(zhǔn)化提供了參考。“共識”中提出 ETS 應(yīng)該先切斷右側(cè)胸交感神經(jīng)后切斷左側(cè)胸交感神經(jīng)以防心率失常[1]。然而 2012 年美國關(guān)于手汗癥治療的專家共識未對先行左側(cè)或右側(cè) ETS 手術(shù)順序進(jìn)行討論[2]。國內(nèi)外有研究對先行左側(cè)或右側(cè) ETS 的患者手術(shù)過程血流動(dòng)力學(xué)變化進(jìn)行對比，這些研究的結(jié)果與結(jié)論大相徑庭[3-4]。……