| Purpose (1) A prospective randomized study was designed to compare the efficiencyand side effects of resection of R4alone with resection of R4combined with R3ramussympathectomy in the treatment of primary palmar hyperhidrosis(PPH).The role of theKuntz fibers in hand sweating is further investigated.(2) Video-assisted thoracoscic sympathectomy(VATS) is an most effective andpersistent procedure for patients with primary palmar hyperhidrosis recently. Thepurpose of this study was to examine social avoidance and distress levels in PPHpatients before and after VETS using the tool of social avoidance and distressscale(SAD) which was frequently used.Methods (1)120consecutive patients with severe PH were randomized into twotherapeutic groups. Group A: underwent resection of R4combined with R3ramussympathecotomy (n=60). Group B: underwent resection of R4sympathectomy (n=60).Assessment was applied preoperatively,3months and6months postoperatively.(2)118patients of severe primary palmar hyperhidrosis under the treatment ofvideo-assisted thoracoscic sympathectomy from Air Force General Hospital wereassessed by the social avoidance and distress scale(SAD) preoperatively and6monthspostoperatively, and93cases of valid date were deeply analyzed.Results (1)91patients were followed up (51cases in group A,40cases in group B). Three months postoperatively,1case(1.96%)of moderate sweating hands occurred ingroup A, compared with1case(2.5%)in group B, and3cases(5.88%)of mild sweatinghands were found in group A, compared with8cases(20%)in group B, P<0.05.Sixmonths postoperatively,1case(1.96%)of moderate sweating hands occurred in group A,compared with3cases(7.5%)in group B, and2cases(3.9%)of mild sweating hands ingroup A, compared with5cases(12.5%)in group B, P<0.05. Meanwhile, three monthspostoperatively,28cases(54.90%)of compensatory sweating occurred in group A,compared with28cases(70%)in group B, P>0.05.Six months postoperatively,30cases(58.82%)of compensatory sweating occurred in group A, compared with31cases(77.5%)in group B, P>0.05.(2)93patients of severe primary palmar hyperhidrosis were followed up, the SAD totalscores, avoidance scores and distress scores [(15.53±7.361),(8.27±4.030),(7.26±3.931)]preoperatively were significantly higher than the norms [(8.030±4.640),(3.92±3.100),(4.14±2.620)] respectively, P<0.05. The SAD total scores, avoidance scores and distressscores [(8.04±6.056),(4.08±3.231),(3.97±3.302)] postoperatively had no significantdifference compared with the norms respectively, P>0.05. While significant differencewas found in the SAD total scores, avoidance scores and distress scores betweenpreoperative and postoperative respectively, P<0.001. Meanwhile, it was no differencein the group of gender, family history, marital status and the course of the diseaserespectively, but when compared in the age group, distress scores in older group(age>22)were significantly higher than the younger(age≤22), P<0.05. Compensatory sweatingwas found in52cases postoperatively. The SAD total scores, avoidance scores anddistress scores [(15.53±7.361),(8.27±4.030),(7.26±3.931)] in compensatory sweatinggroup had no significant difference compared with the control group [(7.59±5.718),(3.63±3.144),(3.95±3.049)], P>0.05. Conclusion (1) Video-assisted thoracoscic sympathectomy in the treatment of primarypalmar hyperhidrosis is safe, effective and high patient satisfaction.(2) The preventiveresection of the R3ramus based on the R4sympathectomy improves the effect ofpatient’s palm moisture.(3) The preventive resection of the R3ramus dosn’t increasethe incidence of compensatory hyperhidrosis.(4) Poor quality of life in severe primarypalmar hyperhidrosis may be improved by the treatment of video-assisted thoracoscopicsympathectomy.(5) The phenomenon of social avoidance and distress has a higherprevalence among severe primary hyperhidrosis.(6) The psychological aspects of socialavoidance and distress in severe primary palmar hyperhidrosis may be improved byvideo-assisted thoracoscopic sympathectomy effectively. |
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