A Clinical Study On Endoscopic Thoracic Sympathectomy For Palmar Hyperhidrosis

Objective:To analyze the long-dated efficacy and complications of video-assisted thoracoscopic in the treatment of palmar hyperhidrosis, and thus to investigate the preservation of the occurrence of compensatory sweating.Methods:Retrospective study of 118 cases palmar hyperhidrosis who were received video-assisted thoracoscopic bilateral sympathectomy from April 2004 to April 2014.Results:All procedures were carried out successfully without severe morbidity or mortality. All cases were followed-up lasting 12～108 months with the average of 33 months. All cases remained satisfactory in palmar sweating control. The curative rate of palmar hyperhidrosis was 100%. The total incidence of compensatory sweating was 35.6% (42/118), including low-grade 21.2%(25/118), medium 14.4%(17/118), there was no high-grade case in our study. No recurrence during the follow-up period was observed. The total satisfaction of surgical treatment was 89.8%(106/118); the incidence of compensatory sweating was 39.1%(25/64)in the high-grade palmar hyperhidrosis cases(95.3% satisfaction),31.5%(17/54) in the medium palmar hyperhidrosis cases(83.3% satisfaction). The satisfaction was 71.4%(20/28) in R2-R4 group,92.7% (38/41) in R3-R4 group,98.0%(48/49) in R4 group, and 89.6%(95/106) in sympathectomy group,91.7%(11/12) in sympathetic nerve clip group. Besides compensatory sweating, there also were other complications,such as mild unilateral pneumothorax 7cases(5.9%), mild wound pain 3 cases(2.5%), slight subcutaneous emphysema 1 case(0.8%), there was no case of Horner syndrome、bradyarrhythmia or hemothorax. The variables as age、gender、family history、medicine treatment、season of surgical procedure、symptom grade and resection way of sympathetic nerve chain could not impact on compensatory sweating incidence(P>0.05). The occurrence of compensatory sweating was concerned with the resection site of sympathetic nerve chain. The incidence of compensatory sweating lower with the resection site of sympathetic nerve chain lower. There was a significantly difference between R2-R4 group and R4 group(P<0.05).Conclusion:Video-assisted thoracoscopic sympathectomy is a safe, effective and minimally invasive operative method to cure hyperhidrosis. The most frequent complication is compensatory sweating. Occurrence rate of compensatory sweating is lower in R4 resecetion than in R2-R4 or R3-R4.