Screening: reasons to be cautious.
Screening: reasons to be cautious.
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筛查：需要谨慎的理由。
DOI：
10.1136/bmj.306.6887.1222
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发表时间：
1993
影响因子：
--
通讯作者：
W. Holland
中科院分区：
文献类型：
--
作者：
W. Holland
肢体的结果和霍默氏综合症的影响（这应该是最小的风险）。背交感神经切除术可通过各种“开放”手术进行。开放性手术的并发症包括Homer’s综合征、t3和T4节段神经不完全去支配、臂丛挫伤、血管损伤、喉返神经麻痹和美容问题。这些并发症超过了潜在的好处，许多医生认为开放手术已经过时了。最近发展的微创技术，包括经皮苯酚注射和计算机断层扫描引导下的经皮射频消融术，提供了更安全的替代方法，但长期效果尚不清楚。目前，最常用的微创技术是内镜下经胸交感神经切除术8，该技术首次为重度局限性上肢多汗症患者提供了一种简单有效的治疗方法。9-2“在腹腔镜胆囊切除术之前，这项原始技术就被很好地描述了，但在各种类型的腹腔镜手术取得进展后，这项技术得到了普及。今年晚些时候将举行第一次专门讨论这一行动的国际会议。美容效果很好。术后疼痛少，患者住院时间不超过48小时。双侧交感神经切除术可以在同一手术中进行。长期并发症与传统背交感神经切除术相似，患者应注意这些风险。最常见的是代偿性出汗，可发生在37-75%的患者中我们不知道如何治疗这种不幸的后果，只选择严重残疾的病人进行手术是至关重要的。如果上肢仅轻微受累，术后严重的躯干多汗症虽然不常见，但可能更严重。味觉出汗也是可能的，但只是一个小麻烦。肋间臂神经痛可能发生，但霍默氏综合征应该是罕见的。等待复发率的长期研究；对于传统的交感神经切除术，它们的范围从0到5%。内窥镜交感神经切除术是治疗严重上肢多汗症的显著进步，是手术治疗的首选。它可能在其他情况下也有作用，但存在这样的危险，即即使交感神经切除术的益处不确定，如在已知只有短暂作用的严重缺血和交感神经营养不良时，如在血管痉挛疾病中，也会推荐手术。仔细选择患者（牢记从开放式交感神经切除术中吸取的教训）和内窥镜技术可以以最小的风险立即获益。
outcome in the limb and the effect of Homer's syndrome (which should be a minimal risk). Dorsal sympathectomy may be performed by various "open" operations. The complications of open operations include Homer's syndrome, incomplete denervation ofT3 and T4 segments, contusion of the brachial plexus, vascular injury, recurrent laryngeal nerve paralysis, and cosmetic problems. These complications outweigh the potential benefits, and many doctors consider open operation to be out of date. The recent development of minimally invasive techniques, which have included percutaneous phenol injection6 and percutaneous radiofrequency ablation7 guided by computed tomography, have provided safer alternatives, but long term effects are unknown. Currently, the most commonly used minimally invasive technique is endoscopic transthoracic sympathectomy,8 which, for the first time, offers a simple and effective treatment for those disabled by severe localised upper limb hyperhidrosis.9-2" The original technique was described well before laparoscopic cholecystectomy but has gained in popularity after the advances in all types of laparoscopic surgery. The first international conference devoted entirely to this operation takes place later this year. The cosmetic result is very good. There is little postoperative pain, and patients need to stay in hospital for less than 48 hours. Bilateral sympathectomies can be carried out at the same operation. Long term complications are similar to those of conventional dorsal sympathectomy, and patients should be warned of these risks. The commonest is compensatory sweating, which may occur in 37-75% of patients.10 We do not know how to treat this unfortunate consequence, and selecting only severely disabled patients for surgery is essential. If the upper limbs are only mildly affected severe postoperative hyperhidrosis of the trunk, though uncommon, may be even worse. Gustatory sweating is also possible but is only a minor nuisance. Intercostobrachial neuralgia may occur, but Homer's syndrome should be rare. Long term studies of recurrence rates are awaited; for conventional sympathectomy they range from zero to 5%. Endoscopic sympathectomy is an appreciable advance in the treatment of severe upper limb hyperhidrosis and is the surgical treatment of choice. It may have a role in other conditions, but there is a danger that the operation will be recommended even when sympathectomy is of uncertain benefit-as in critical ischaemia and sympathetic dystrophyor when it is known to have only a transient effect-as in vasospastic disease. Careful selection of patients (bearing in mind the lessons learnt from open sympathectomy) and endoscopic technique offer immediate benefit with minimum risk.