Efficacy And Safety Of Endoscopic Thoracic R4 Sympathicotomy Combined With R3 Ramicotomy In The Treatment For Primary Palmar Hyperhidrosis

Objective:To evaluate the safety and efficacy of R4 sympathectomy combined with R3 ramictomy and R3 sympathectomy in the treatment of primary palmar hyperhidrosis;to explore the incidence and severity of compensatory hyperhidrosis after different surgical methods at the same time,the postoperative follow-up satisfaction,palmar effect,and quality of life were investigated and analyzed;the discomfort caused by compensatory hyperhidrosis in patients with compensatory hyperhidrosis after endoscopic thoracic sympathectomy was compared in different seasonal environme-nts differences in sensory quantification scores.Methods:The clinical data of 109 moderate and severe primary patients who underwent endoscopic thoracic sympathectomy in our center(thoracic surgery department of the First Affiliated Hospital of Nanchang University)from May 2018 to June 2021 were retrospectively analyzed.According to the different surgical methods,the patients were divided into groups A and B.The patients in group A all received endoscopic thoracic R4 sympathectomy combined with R3 ramictomy,while the patients in group B all received endoscopic thoracic R3 sympathectomy.Postopera-tive patients were followed up,and the WHOQOL-BREF scale was used to evaluate the postoperative quality of life of the patients.In late July 2021 and early January 2022,the two groups of patients with postoperative compensatory hyperhidrosis were interviewed by telephone.During the follow-up,the patients were quantitatively scored for the discomfort caused by compensatory hyperhidrosis,and the differences in scores between summer and winter were compared.RESULTS:A total of 102 patients completed follow-up,and 7 patients were lost to follow-up,with a loss-to-follow-up rate of 6%(7/109).There were 54 patients in group A and 48 patients in group B.There were no significant differences in gender,age,BMI,family history,and preoperative grade of primary palmar hyperhidrosis between the two groups,P>0.05.There was no significant difference in the amount of blood loss,catheter placement rate,intraoperative and postoperative complications,and hospital stay,P>0.05.There was no significant difference in the satisfaction rate and palmar effect between the two groups,P>0.05,and there was no significant difference in the total QOL score,P>0.05,but the psychological domain score of group A was 14.15±2.06 higher than that of group B,13.30±1.86,P=0.004.The incidence of compensatory hyperhidrosis in group A was significantly lower than in group B,P=0.019.The quantitative score of discomfort caused by compensatory hyperhidrosis in summer was 6.22±1.96,which was significantly higher than that in winter 4.00±2.64,P<0.001.Conclusion:Both surgical methods are safe and effective for primary palmar hyperhidrosis.The incidence of compensatory hyperhidrosis in endoscopic thoracic R4 combined with R3 ramictomy is lower than that in bilateral R3 sympathectomy,and endoscopic thoracic R4 combined with R3 ramictomy Postoperative QOL psychological domain scores in patients with amputation were higher than those with bilateral R3 sympathectomy.The discomfort caused by compensatory sweating is higher in summer than in winter.