The Effect Of Thoracoscopic Sympathectomy In The Treatment Of Palmar Hyperhidrosis

Primary palmar hyperhidrosis(PPH)is a chronic disease.It is manifested as excessive sweat secretion from palmar skin sweat glands,which can be accompanied by increased sweat secretion from other parts of the body,such as the craniofacial,axillary,plantar,etc.it can increase sweat secretion when stimulated by external emotions,heat or body[1]Excessive sweating will not only cause physical discomfort and greatly reduce the quality of life of patients,but also cause social fear,lifelong mental disorders and other psychological problems[2-4]About 93%of palmar hyperhidrosis patients in the United States are primary palmar hyperhidrosis,90%of them have typical lesions and bilateral distribution,affecting the armpit,palm,foot base and craniofacial area[5]Secondary palmar hyperhidrosis is more widely and asymmetrically distributed and caused by various potential diseases or drugs[6]Primary palmar hyperhidrosis can occur at any age.The average age of onset is between 14 and 25 years old.The common anatomical sites of sweating are:armpit,sole,palm,face[7]The severity of palmar hyperhidrosis can be divided into three levels:light(slightly wet palms),medium(wet handkerchiefs),and heavy(drops of sweat are like drops of water)[8]Thoracoscopic sympathetic blockade is regarded as the gold standard for the treatment of palmar hyperhidrosis.This method has the advantages of small trauma,fast recovery and good effect,which can be recognized by the vast majority of patients[9,10].Endoscopic sympathectomy is the most common way to block the sympathetic nerve chain.The cutting plane varies from T2 to T4 and sometimes extends to T6[11].The treatment effect is different with the different level of the cut sympathetic nerve.We compared the effects of three different endoscopic sympathectomy(T4 sympathectomy+T5 sympathetic electrocoagulation,T4 sympathectomy+T3 sympathetic electrocoagulation,T4 sympathectomy)on the treatment of primary palmar hyperhidrosis and the elimination of foot and axillary hyperhidrosis.Research purpose:Three kinds of thoracoscopic sympathectomy in the treatment of palmar hyperhidrosis were compared in terms of the surgical situation,postoperative effect and postoperative satisfaction.The effects of three kinds of surgical methods on palmar hyperhidrosis,foot hyperhidrosis and axillary hyperhidrosis were evaluated.Research methods:This study is a randomized controlled prospective study,which has been approved by the ethics committee of our hospital.From August 2017 to December 2019,75 patients with palmar hyperhidrosis in our hospital were selected as the study object.By using the random number table method,75 patients were randomly divided into three groups:A,B and C,25 in each group.T4 thoracic sympathectomy was performed in group A,which was the control group.Group B received T4 sympathectomy+T3 sympathetic electrocoagulation,group C received T4 sympathectomy+T5 sympathetic electrocoagulation,and groups B and C were the study groups.The operation conditions(operation time,hospitalization days,postoperative complications),postoperative effects(reduction of hand sweat,axillary sweat and foot sweat,incidence of compensatory hyperhidrosis)and postoperative satisfaction were compared.Results:1.Palmar hyperhidrosis was improved in all patients,and the effective rate was 100%.2.Reduction of hand sweat:the near normal degree of T4+T3 group was better than T4 group and T4+T5 group,but there was no difference between T4+T5 group and T4 group(PABC=0.002,PAB=0.001,PAC=0.193,PBC=0.019).3.Axillary sweat reduction:the axillary sweat reduction rate(>40%)of T4+T3 electrocoagulation damage group was better than T4 and T4+T5 electrocoagulation damage group,and the axillary sweat improvement rate of T4+T5 electrocoagulation damage group was higher than T4 group(PABC=0.001,PAB=0.000,PAC=0.044,PBC=0.048).4.Reduction of foot sweat:the reduction rate(>30%)of T4+T5 group was better than T4 group and T4+T3 group,and the improvement rate of T4+T3 group was higher than T4 group(PABC=0.001,PAB=0.044,PAC=0.000,PBC=0.048).5.There was no difference in the incidence of compensatory hyperhidrosis among the three groups(PABC=1.000,PAB=0.500,PAC = 0.613,PBC = 0.500).Conclusion:1.There were no differences among the three groups in terms of hospital stay,operation duration,postoperative complications and the incidence of compensatory hyperhidrosis.2.Three kinds of operation methods are all effective methods for the treatment of primary palmar hyperhidrosis.Patients with simple palmar hyperhidrosis can first consider cutting off T4 segments.According to the situation of combined foot sweat and axillary hyperhidrosis,different segments are added for better effect.3.T4+T3 electrocoagulation group was better than T4 and T4+T5 electrocoagulation group.For those with more axillary sweat,T3 sympathetic nerve can be electrocoagulated on the basis of T4 sympathectomy.4.The therapeutic effect of T4+T5 electrocoagulation damage group is better than that of T4+T3 damage group.On the basis of T4 sympathectomy,the patients with severe foot perspiration can electrocoagulate T5 sympathetic nerve.