| ObjectivePalmar hyperhidrosis has a certain morbidity in various regions of China. Palmar hyperhidrosis affects people’s work, study and social communication, especially for students and soldiers. Endoscopic thoracic sympathectomy (ETS) is currently the most widely used and the most effective treatment technology, and with the development of thoracoscopic technology, ETS has become more and more mature. Since our centre started ETS in1998, we made several efforts to develop the surgical procedures(position, incision, process, et al), instrument, anesthesia intubation and surgical range, gradually establish a normative and effective treatment strategies for ETS, we also innovativlly to do ETS via a single unilateral incision approach by the pleura videoscope and research to develop the natural orifice translumenal endoscopic surgery(NOTES) on ETS (through the esophagus). This study retrospective analysis167cases of palmar hyperhidrosis in our center from1998to2015, according to the grouping operation mode in different stages and analyse several preoperative, in operation and postoperative parameters, the efficiency of operation and the occurrence rate of complications, to demonstrate the patient profit from the development of minimally invasive techniques and concepts and provide practical and theoretical basis for the innovation and development for the minimally invasive treatment of palmar hyperhidrosis in the future.MethodRetrospectively analyse all the palmar hyperhidrosis cases in our centre from1998to2015, divide to five groups according the treatment methods:CT guided percutaneous ethanol injection group, lateral position turning in the operation and bilateral three or two hole group(lateral position-3or2hole group), supine position and bilateral three or two hole group(supine position-3or2hole group), supine position and bilateral single hole group(supine position-single hole group) and unilateral unique hole pleura videoscope group. Collect the operation data(surgical range, anesthesia intubation way, operation time and amount of bleeding), hospitalization data(hospitalization days after operation and in hospital complications), follow up data(efficiency of treatment and if compensatory hyperhidrosis, hands dry and horner syndrome happened) of all cases and analyse the difference between groups.ResultFrom1998to2015, there were167patients of palmar hyperhidrosis came to our centre,75males and92females, the average age is22.0±5.5years old(12～43), among the167cases,9accepted CT guided percutaneous ethanol injection treatment, other158accepted surgical treatment. Among the surgical groups, there were69cases in the lateral position-3or2hole group,24cases in the supine position-3or2hole group,49cases in the supine position-single hole group and16in the unilateral unique hole pleura videoscope group, the age and gender composition has no significant statistical difference between groups. The results show that surgical treatment had obvious high efficiency than CT guided percutaneous ethanol injection treatment, and the occurrence rate of complications had no significant statistical difference. In the process of technology improvement, we first changed the operation position from lateral position to supine position to save the step of turning position in the operation, the data showed the operation time, amount of bleeding and hospitalization days after operation obviously reduced, the treatment efficiency and complications incidence had no statistical difference; on the side of incisions, we made3incisions on two sides at the start, and then bilateral2incisions, and bilateral1incisions now, the data showed incision reducing did not lead to the operation time, amount of bleeding and hospitalization days after operation increasing and also the treatment efficiency and complications incidence had no statistical difference, incision reducing could obviously depress the pain of patients after operation, improve the appearance and increase the patients’ satisfaction degree; on the side of operation range, we change the range from T2-T4to just cut off T3or T4ganglion, change the cut off method from complete resection to electric coagulation, the results showed the efficiency has no difference and just cut off T3or T4ganglion obviously reducing the incidence of compensatory hyperhidrosis. In addition, the surgical method of unilateral unique hole pleura videoscope group also had the same operation parameter with others in the same time, and this technology could go a step further to reduce incision and fit the patients with specific needs of the postoperative appearance. The animal experiment suggested that NOTES by esophagus to do ETS is operative and the postoperative complications such as esophageal fistula is in the controllable range.Conclusion1. ETS is still the most effective method of all the treatment for palmar hyperhidrosis, CT guided percutaneous ethanol injection is still in the initial stage of exploration, the clinical application should be cautious;2. In the process of ETS technology improvements, we could see the development of minimally invasive techniques and concepts in the thoracic surgery, the improvements of all the details of operation gradually accelerate the postoperative recovery and reduce the incidence of complications, demonstrates the practicality of minimally invasive techniques and concepts;3. Along with the development of social economic level and the need for life quality of patients, patients has more and more needs of the postoperative appearance, we made lots of efforts on this purpose, such as single hole techniques of thoracoscope, using hidden location of incision and the technique of unique hole pleura videoscope sympathectomy develop by our centre. The animal experiments in our centre has confirmed the feasibility of NOTES on ETS by esophagus and should to be raised by more further research and then clinical application. |
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