A Clinical Study Of Endoscopic Thoracic Sympathectomy At Different Levels In The Treatment Of Primary Palmar Hyperhidrosis

Objective: To investigate the long-term effects and complications of ETS at different levels in the treatment of PPH,and to seek the best surgical modality for the treatment of PPH.Methods: A total of 162 patients with PPH who underwent ETS in the First Affiliated Hospital of Guangxi Medical University from August 2012 to December 2019 were selected for postoperative followup.According to the different planes of the thoracic sympathetic nerve chain transection,the highest plane of the sympathetic nerve chain as the standard is divided into 3 groups:(1)Group T2(n=33):(T2、T2+T3、T2+T3+T4)thoracic sympathectomy;(2)Group T3(n=61):(T3、T3+T4)thoracic sympathectomy;(3)Group T4(n=68): T4 thoracic sympathectomy.The clinical and followup data of the three groups were compared and analyzed by SPSS22.0.Results: All operations were performed under thoracoscopy,there was no case of conversion to thoracotomy,the effective rate of operation was 100%.There were no serious postoperative complications or perioperative deaths.There was no statistically significant difference in age,gender,family history,preoperative adjuvant therapy,preoperative quality of life,postoperative hand sweat recurrence rate,incidence of transient hyperhidrosis 7 days after operation,postoperative satisfaction,foot sweat improvement rate and axillary sweat improvement rate among the three groups(P≥0.05).There was no statistically significant difference in postoperative CH between T2 and T3,T3 and T4 groups,and there was no significant difference in postoperative quality of life between T3 and T4 groups(P≥0.05).There were statistically significant differences in postoperative quality of life and corresponding preoperative quality of life among the three groups(P<0.05).Differences in postoperative quality of life between T2 and T3 groups,T2 and T4 groups,and postoperative CH in T2 and T4 groups were statistically significant(P<0.05).Conclusion:1.ETS is a safe and effective method for the treatment of PPH.2.Appropriately reducing the cutting plane of the thoracic sympathetic nerve chain can reduce the incidence of postoperative compensatory hyperhidrosis,improve the patient’s quality of life after surgery,and will not increase the risk of recurrence of postoperative hand sweat.3.In some patients with PPH complicated with foot sweat and axillary sweat,the symptoms of foot sweat and axillary sweat can be improved after ETS.