Objective: To compare compensatory sweating after T2-4 and T3-4 endoscopic thoracic sympathecto-my for the treatment of palmar hyperhidrosis, and thus to investigate the potential mechanism of the occurrence of compensatory sweating. Methods; One hundred and forty-six patients with primary palmar hyperhidrosis were divided into two groups; 66 with T2-4 sympathectomy (T2-4 group) and 80 with T3-4 sympathectomy (T3-4 group). The effects of operation, compensatory sweating location and severity one day and 6 months after operation were compared. Results; The effective rate was 100% , and the most common compensatory sweating locations were on the back and the chest The compensatory sweating incidence was 39% and 21% respectively in T2-4 and T3-4 group with significant difference ( P < 0. 05 ). There were 2 cases of severe compensatory sweating in T2-4 group, and T3-4 group without severe case 1 day after operation. The compensatory sweating incidence was 24% and 11 % respectively , with significant difference ( P < 0. 05). There was 1 case of severe compensatory sweating in T2-4 group, and T3-4 group without severe case 6 months after operation. Conclusion; Lowering the level of sympathectomy for primary palmar hyperhidrosis results in less compensatory sweeting. T3-4 sympathectomy is an ideal operation method to reduce compensatory sweating.%目的:通过比较胸腔镜下T2-4与T3-4交感神经链切断治疗手足多汗症术后代偿性出汗发生情况,探讨其发生的可能机制.方法:手足多汗症患者146例,按不同手术方式分为T2-4组(行T2-4水平交感神经链切断术,共66例)与T3-4组(行T3-4水平交感神经链切断术,共80例).比较两组术后第1日、第6个月手术效果以及代偿性出汗发生部位和严重程度.结果:术后两组手汗治愈率100％,最常见代偿性出汗部位是背部和胸部.术后第1日T2-4组代偿性出汗发生率明显高于T3-4组(39％对比21％,P＜0.05),T2-4组出现2例重度代偿性出汗,T3-4组无重度者.术后6个月T2-4组代偿性出汗发生率依然明显高于T3-4组[24％ (16/66)对比11％ (9/80),P＜0.05].T2-4组仍有1例重度代偿性出汗患者.结论:降低胸交感神经链切断位置可减少代偿性出汗发生率和严重程度,T3-4切断术是一种较为理想的手术方式.代偿性出汗可能随时间有缓解趋势.
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