[1]杨劼* 古卫权 杨胜利 叶俊 王飞 肖叶 张小文 赵宁 吴玲玲 吴卓鹏.手汗症术中特殊情况的处理[J].中国微创外科杂志,2021,01(9):797-799.
　Yang Jie,Gu Weiquan,Yang Shengli,et al.Management of Special Situations During the Surgery for Palmar Hyperhidrosis[J].Chinese Journal of Minimally Invasive Surgery,2021,01(9):797-799.
点击复制

手汗症术中特殊情况的处理()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年9期
页码:
797-799
栏目:
临床研究
出版日期:
2021-09-25

文章信息/Info

Title:
Management of Special Situations During the Surgery for Palmar Hyperhidrosis
作者:
杨劼* 古卫权 杨胜利 叶俊 王飞 肖叶 张小文 赵宁 吴玲玲 吴卓鹏
（中山大学附属佛山医院广东省佛山市第一人民医院胸外科，佛山528000)
Author(s):
Yang Jie;  Gu Weiquan;  Yang Shengli;  et al.
Department of Thoracic Surgery, First People’s Hospital of Foshan, Foshan 528000, China
关键词:
手汗症; 粘连; 出血; 肺大疱; 复发
Keywords:
Palmar hyperhidrosis; Adhesion; Bleeding; Pulmonary bullae; Recurrence
文献标志码:
A
摘要:
目的总结手汗症术中特殊情况的处理经验。方法2003年4月~2021年7月对2218例手汗症行腔镜R4胸交感神经链切断术，其中52例术中遇到特殊情况：①胸腔粘连26例，用电凝吸引器、超声刀或LigaSure血管闭合器分离。②术中出血11例，均用电凝吸引器电凝止血。③交感神经显露不清7例，用电凝吸引器从上往下触碰敲打胸椎旁2~5肋骨，在第4肋骨表面灼开脂肪组织，显露肋骨，再灼断交感神经。④小肺大疱5例，用7号丝线套扎或直接用切割缝合器切除。⑤手汗复发二次手术3例，术中见肺组织与第4肋骨交感神经灼断处广泛或部分融合粘连，灼断R3交感神经。 结果全组手术时间40~50 min，平均42 min，无并发症发生，术后多汗症状消失。术后随访3~12年，中位数6年，均无复发。结论应重视手汗症术中出现的特殊情况,掌握处理方法，保证手术的安全性。
Abstract:
ObjectiveTo summarize the treatment experience in handling of special situations during the operation for palmar hyperhidrosis.MethodsFrom April 2003 to July 2021, there were 2218 cases of palmar hyperhidrosis receiving thoracoscopic R4 sympathectomy, 52 of which encountered special situations during operation: ①there were 26 cases concurrent with thoracic adhesion, and electrocoagulation aspirator, ultrasonic knife or LigaSure were used to separate the adhesion; ②a total of 11 patients suffered of bleeding during operation, which were stopped by using the electrocoagulation aspirator; ③unclear exposure of the sympathetic nerve occurred in 7 cases, which were treated with pushing or beating the ribs with the electrocoagulation aspirator from the top down, cutting open the adipose tissue on the surface of the fourth rib untill the ribs was exposed, and dissecting the sympathetic nerve; ④there were 5 patients concomitant with small pulmonary bullae, which were ligated by a No.7 suture or resected by endoscopic cutting stapler; ⑤a total of 3 cases were recurrent and received reoperation, and because of the surgical difficulty due to extensive thoracic adhesion, the R3 sympathetic nerve was cutted.ResultsThe operation duration ranged 40-50 min (mean, 42 min). No complications occurred. The symptoms of palmar hyperhidrosis were all disappeared. The followup time was 3 years to 12 years after operation (median, 6 years). There was no case of recurrence.ConclusionAttention should be paid to handling of special conditions during the operation for palmar hyperhidrosis, only in this way can we ensure the safety of the operation.

参考文献/References:

[1]杨劼,谭家驹,李文军,等.电视纵隔镜胸交感神经链切断术治疗手汗症55例报告.中国微创外科杂志,2004,4(1):29-30.
[2]杨劼，王俊，谭家驹，等．胸交感神经链切断术治疗手汗症手术方法的改进．中华胸心血管外科杂志，2005，21（6）：377-378.
[3]Yang J,Tan J,Ye G,et al.T3/T4 thoracic sympathictomy and compensatory sweating in treatment of palmar hyperhidrosis.Chin Med J (Engl),2007,120(18):1574-1577.
[4]Liu Y,Yang J,Liu J,et al.Surgical treatment of primary palmar hyperhidrosis: a prospective randomized study comparing T3 and T4 sympathicotomy.Eur J Cardiothorac Surg,2009,35(3):398-402.
[5]涂远荣,杨劼,刘彦国.中国手汗症微创治疗专家共识.中华胸心血管外科杂志,2011,27(8):449-451.
[6]周冰,梅富杨,孙高忠,等.胸腔镜治疗手汗症:先左侧还是先右侧?浙江医学,2017,39(11):908-910,921.
[7]涂远荣.交感神经切断术后代偿性多汗的防治对策与思考.中国微创外科杂志,2017,17(2):97-98.
[8]滕洪,王述民,曲家骐,等.自发性气胸肺大疱分型及胸腔镜手术方法探讨.中国微创外科杂志,2013,13(7):584-587.
[9]涂远荣,林敏,陈剑锋,等.胸交感神经切断术治疗原发性手汗症2206例：10年结果和分析.中国微创外科杂志,2017,17(2):99-103.
[10]侯智亮.手汗症术后复发的胸腔镜再手术疗效观察.医药论坛杂志,2008,29(23):65-66.
[11]刘彦国,石献忠,于恩华,等.上胸段交感神经链切断手术的应用解剖研究.中华胸心血管外科杂志,2005,21(2):75-77.
[12]Alhetheli G.Outcome using either intradermal botox injection or endoscopic thoracic sympathectomy for patients with primary palmar hyperhidrosis:a comparative study.Cosmetics,2021,8(2):41.

备注/Memo

备注/Memo:
*通讯作者，Email:yjie@fsyyy.com
更新日期/Last Update: 2021-12-09