The Long-dated Efficacy And Complications Of Video-assisted Thoracoscopic Sympathecotomy In The Treatment Of Palmar Hyperhidrosis By Different Operative Methods.

Objective:To analyze the long-dated efficacy and complications of video-assisted thorac -oscopic sympathicotomy in the treatment of palmar hyperhidrosis by different operative methods in order to search after the best operative methods.Methods:Retrospective study of 542 cases(408 cases available) palmar hyperhidrosis who underwent video-assisted thoracoscopic bilateral sympathecotomy during July 1995 and Dec 2007.Follow-up lasting 12～150months with the average of 58 months.The patients were divided into four groups by different operative methods. (1)Group A(n=82):Video-assisted thoracoscopic T2-4 sympathecotomy were performed. (2)Group B(n=135):Video-assisted thoracoscopic T2 sympathetomy were performed. (3)Group C(n=41):Video-assisted thoracoscopic T2 sympathetic nerve clipped. (4)Group D(n=150):Video-assisted thoracoscopic T3-4 level sympathecotomy plus bypass fiber(Kuntz fiber) resection on same level were performed. Results:All the cases underwent video-assisted thoracoscopic bilateral sympathecotomy. All operations were successfully performed under thoracoscope without severe morbidity and mortality.The curative rate of palmar hyperhidrosis was 100.00%. 92.7%of the patients found the quality of their life improved significantly when 5.39%found no changing and 1.96%felt even worse.The incidence of compensatory sweating of four groups were 42.2%,including low-grade 13.97%(a little influence to daily life),medium 21.32%(underwear become humid but patients can bear), high-grade 7.35%(compensatory sweating heavyly that patients can't bear).The incidence of compensatory sweating were 54.9%(group A),48.1%(group B),48.8% (group C) and 28.0%(group D) respectively with significantly decrease in groupD contrast to other three groups(group D contrast to group A,x~2=19.297,P＜0.01;contrast to group B,x~2=15.190,P＜0.01;contrast to group C,x~2=7.767,P＜0.01).Other pairings have nonsignificance.The incidence of high-grade compensatory sweating which have important infleuces on daily life were 9.8%(group A),10.4%(group B),9.8% (group C) and 2.7%(group D) respectively with significantly decrease in group D (group D contrast to group A,x~2=5.433,P=0.020;contrast to group B,x~2=6.141,P =0.013;contrast to group C,x~2=4.033,P=0.045).Besides compensatory sweating, there also are other complications,such as pneumothorax(41 cases),hemothorax(8 cases),rhinitis(one case),chest pain(12 cases),Homer's syndrome(3 cases) which happened in group A(2 cases) and group B(one case).The complications except compensatory sweating released in 6 months without bad affect to daily life. So there are nonsignificance to analyze.There were 8 cases relapse and the relapse rate were 1.2%(group A),2.2%(group B),7.3%(group C) and 0.7%(group D). Only when group D contrasted to group C has significantly decrease in the relapse rate(x~2=6.945,P=0.008).Other pairings have nonsignificance.Contrasted to preoperative,the 8 patients felt that the relapse sweating lessened by different degree include 6 patients considered that was the normal standard.Only 2 patients who from group C(T2 clipped) felt there was no improvement of the quality of their life.Conclusion:Video-assisted thoracoscopic bilateral sympathecotomy is an effective operative method to cure hyperhidrosis.The most frequent complication is compensatory hyperhidrosis.By evaluating the long-dated efficacy and complications of the four different operative methods,we have the conclusion that the T3 sympathicotomy plus bypass fiber resection procedure is reasonable operative method to cure hyperhidrosis with the best curative effectand lowest incidence of compensatory hyperhidrosis.