摘要
目的应用前瞻性随机对照研究,比较R4(第4肋骨表面交感神经主干)交感神经链联合R3(第3肋骨表面交感神经主干)侧枝切断术与单纯R4切断术治疗原发性手汗症(PH)的疗效,以及术后代偿性多汗等并发症,探讨旁路纤维(Kuntz束支)在手汗支配中的作用。方法选择连续就诊的重度手汗症患者120例,依据患者就诊先后次序随机分为A组(施行R4联合R3侧枝切断术)60例、B组(施行单纯R4切断术)60例。术前和术后6个月分别评估患者情况。结果术后6个月随访到患者91例(75.8%),其中A组51例,B组40例。术后6个月,A、B两组双手出现中度出汗分别为1例(1.96%)、3例(7.5%),轻度出汗2例(3.9%)、5例(12.5%),差异有统计学意义(P<0.05)。A、B两组代偿性出汗分别为30例(58.82%)、31例(77.5%),两组比较差异无统计学意义。结论胸腔镜下胸交感神经链切断术(VATS)治疗手汗症安全、有效,患者满意度较高。在单节段R4切断基础上增加R3侧枝的预防性切除,可增加患者术后手掌效果,更接近于生理状态,且不增加代偿性多汗的发生率。
Objective A prospective randomized study was designed to compare the efficiency and side effects of resection of R4 alone with resection of R4 combined with R3 ramus sympathectomy in the treatment of palmar hy- perhidrosis （PH）. The role of the Kuntz fibers in hand sweating was further investigated. Methods 120 consecutive patients with severe PH were randomized into two therapeutic groups. Group A： underwent resection of R4 com- bined with R3 ramus sympathecotomy （ n = 60）. Group B ： underwent resection of R4 sympathectomy （ n = 60）. Assessment was applied to pre-operatively and 6 months postoperatively. Results 91 patients were followed up （51 cases in group A, 40 cases in group B） at six months postoperatively. Six months postoperatively, 1 case（ 1.96% ） of moderate sweating hands occurred in group A, compared with 3 cases （7.5 % ） in group B ; and there were 2 ca- ses（3. 9% ）of moderate sweating hands in group A, compared with 5 cases（ 12.5% ）in group B （P 〈0.05）. Meanwhile, 30 cases （58.82%） of compensatory sweating occurred in group A, compared with 31 cases （77.5 % ） in group B （P 〉 0. 05 ）. Conclusion The treatment of PH with thoracoscopic sympathectomy under the thoracoscopic is safe, effective with high patient satisfaction. The preventive resection of the R3 ramus based on the R4 sympa- thectomy improves the effect of patient＇s palm while not increase incidence of compensatory hyperhidrosis.
出处
《安徽医科大学学报》
CAS
北大核心
2014年第6期792-795,共4页
Acta Universitatis Medicinalis Anhui
基金
首都市民健康项目培育(编号:Z111107067311057)
