使用硬质输尿管镜行单孔胸交感干切断术治疗手汗症6例

摘要

Objective To summarize the clinical experience of single-port thoracic sympathectomy for palmar hyperhidrosis by using rigid ureteroscope. Methods From March 2012 to February 2014, we used Wolf Fr8/9.8 rigid ureteroscope to replace the traditional thoracoscope in bilateral thoracic sympathetic trunk cutting via a 3-4 mm incision in the treatment of 6 cases of palmar hyperhidrosis .A columnar electrode was introduced through the operation hole and the T 3 thoracic sympathetic trunk and Kuntz beam were cut off. Results The operation was completed successfully in 5 cases, while an extended incision to 12 mm for ultrasonic knife dissection was required because of intrathoracic adhesions in 1 case.Unilateral pneumothorax was occurred in 1 patient.No perioperative death was found .Symptoms disappeared after the operation , and palms were all warm and dry .Follow-up for 9 -21 months (mean, 12.3 months) found 1 case of bilateral axillary compensatory hyperhidrosis .No recurrence was found. Conclusions Use of rigid ureteroscope instead of traditional thoracoscope in single-port thoracic sympathectomy for palmar hyperhidrosis is safe , feasible, and effective.The incision is small without need of suture .%目的：总结使用硬质输尿管镜行单孔法胸交感干切断治疗手汗症的临床经验。方法2012年3月～2014年2月，使用德国Wolf Fr8／9．8硬质输尿管镜替代传统胸腔镜，采用单孔法行双侧胸交感干切断治疗手汗症6例，男性取乳晕切口，女性取乳腺边缘第3肋间切口3～4 mm，柱状电极经操作孔电凝切断T3胸交感干及外侧3～5 cm Kuntz束。结果5例手术顺利完成，1例因胸内粘连扩大切口至12 mm置入超声刀分离。1例术后单侧少量气胸，无围术期死亡。术后手汗症状消失，手掌温暖干爽。随访9～21个月，平均12．3月，1例双侧腋窝代偿性多汗。无复发病例。结论使用硬质输尿管镜替代传统胸腔镜行单孔法交感干切断治疗手汗症安全可行，手术切口小，无须缝合，疗效确切。