Observation Of CT-guided Percutaneous Sympathetic Ganglion Radiofrequency Thermocoagulation Combined With Absolute Ethanol Injection In The Treatment Of Primary Palmar Hyperhidrosis

Objective : To investigate the efficacy and complications of CT-guided percutaneous sympathetic ganglion radiofrequency thermocoagulation combined with absolute Ethanol injection in the treament of primary palmar hyperhidrosis.and thus to clinical investigation data supporting its application.Methods:Sixty eligible patients diagnosed as primary palmar hyperhidrosis in the Deparament of Pain Medicine between March 2020 and January 2021 were enrolled and randomly divided into three groups: absolute Ethanol group(group A),radiofrequency thermocoagulation(group B),absolute Ethanol + radiofrequency thermocoagulation group(group C),20 cases in each group.Bilateral palm temperature and blood perfusion index(Perfusion Index,PI)is measured and recorded For three groups of patients with preoperative(T0),intraoperative operation(group A and C injection of anhydrous ethanol,group B radio frequency)after 30 minutes(T1),postoperative 24 hours(T2),Hand sweat disease severity scale(Hyperhidrosis Disease Severity Scale,HDSS)and dermatology life quality scale(Dermatology Life Quality Index,DLQI)were used to evaluate the alterationgs of sweat severity and the improvement of dermatology life quality each palm 1 week、1 month、3 months、6months 、 9 months 、 12 months postoperatively when compared to preoperative condition,respectively.intraoperative and postoperative complications along with Compensatory sweating(Compensatory Hyperhidrosis,CH)were also documented and compared ammong the three groups.Results : There was no statistical difference regarding preoperative general condition among the three groups.The palm temperature and PI at T1～T2 of the three groups were significantly higher than those at T0(P<0.05),Comparison among the three groups showed that the palm temperature and PI at T1～T2 in group C were significantly higher than those of group A and group B(P<0.05).The HDSS and DLQI scores of the three groups were significantly lower than those before operation(P<0.05).Comparison among the three groups showed that the HDSS scores and DLQI scores in group C were significantly lower than those in group A at 6 months follow-up(P < 0.05).In addition,the HDSS scores and DLQI scores group of group C 9 months and 12 months postoperatively were lower than those of group A and group B(P < 0.05).There were 6 cases with chest back or axillary pain,1 case with chest tightness in group A;5 cases with chest back or axillary pain,1 case with chest tightness in group B;8 cases with chest back or axillary pain,1 case with chest tightness in group C.There was no statistically significant difference(p > 0.05).There were 5 cases with mild CH,2 cases with moderate CH,1 case with severe CH in group A;4 cases with mild CH,3 cases with moderate CH,1 case with severe CH in group B;6 cases with mild CH,3 cases with moderate CH,1 case with severe CH in group C.There was no statistically significant difference(p > 0.05).There was no infinitely heavy CH in three groups.Conclusions : The effect of CT-guided percutaneous sympathetic ganglion radiofrequency thermocoagulation combined with absolute Ethanol injection is better compared with CT-guided percutaneous sympathetic ganglion radiofrequency thermocoagulation or absolute Ethanol injection alone in the treatment of primary palmar hyperhidrosis.There were no extremely severe compensatory sweating and severe complications.