Transareolar single-port endoscopic thoracic sympathectomy with a flexible endoscope for primary palmar hyperhidrosis: a prospective randomized controlled trial.
Transareolar single-port endoscopic thoracic sympathectomy with a flexible endoscope for primary palmar hyperhidrosis: a prospective randomized controlled trial.
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软内镜经乳晕单孔内镜胸交感神经切除术治疗原发性手汗症：一项前瞻性随机对照试验
DOI：
10.21037/atm-20-7399
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发表时间：
2020-12
影响因子：
--
通讯作者：
Tu YR
中科院分区：
文献类型：
--
作者：
Lin JB;Kang MQ;Chen JF;Du Q;Li X;Lai FC;Tu YR
摘要利用软式内视镜进行经鼻孔单孔内视镜胸交感神经切除术的报告并不多见。本研究评估了这种新型微创技术治疗原发性手掌多汗症（PPH）的性能。从2019年1月至2019年9月，118例需要单孔和双侧ETS的重度PPH男性患者被随机分配接受使用软式内窥镜的经鼻孔ETS（A组，n=58）或使用5 mm胸腔镜的经腋下ETS（B组，n=60）。两组患者特征相似。所有手术均成功进行，无死亡或转为开放手术。所有患者术后即刻手掌干燥温暖。与B组相比，A组的中位切口长度显著更短[5.1（5.0-5.2）vs. 10.9（10.8-11.9）mm; P<0.001]，中位术后疼痛评分显著更低[1（1.0-2.0）vs. 3（3.0-4.0）; P<0.001]。两组在手术时间、手掌温度升高和术后一过性出汗方面无差异。完全随访后，A组的中位美容评分显著高于B组[4.0（3.0-4.0）vs. 3.0（3.0-3.0）; P<0.001]。两组在症状缓解、代偿性多汗症和满意度评分方面无差异。无患者报告残余疼痛或症状复发。采用软式内窥镜的经乳晕单孔ETS安全、有效、微创，切口小、疼痛小，美容效果极佳。这种新的手术方法适用于男性PPH的常规治疗。
Transareolar single-port endoscopic thoracic sympathectomy (ETS) with a flexible endoscope has rarely been reported. This study assessed the performance of this novel minimally invasive technique for primary palmar hyperhidrosis (PPH). From January 2019 to September 2019, 118 males with severe PPH requiring single-port and bilateral ETS were randomly allocated to undergo transareolar ETS using a flexible endoscope (group A, n=58) or transaxillary ETS using a 5 mm thoracoscope (group B, n=60). Both groups had similar patient characteristics. All procedures were performed successfully, with no mortality or conversion to open surgery. All patients had dry and warm palms immediately after surgery. Compared with group B, group A had a significantly shorter median incision length [5.1 (5.0–5.2) vs. 10.9 (10.8–11.9) mm; P<0.001], and significantly lower median postoperative pain score [1 (1.0–2.0) vs. 3 (3.0–4.0); P<0.001]. There were no differences between the two groups in operative time, palmar temperature increase, and transient postoperative sweating. After complete follow-up, group A had a significantly higher median cosmetic score than group B [4.0 (3.0–4.0) vs. 3.0 (3.0–3.0); P<0.001]. There were no differences between the two groups regarding symptom resolution, compensatory hyperhidrosis, and satisfaction score. No patient reported residual pain or symptom recurrence. Transareolar single-port ETS with a flexible endoscope is safe, effective, and minimally invasive with a small incision, minimal pain, and excellent cosmetic results. This novel procedure is suitable for routine treatment of PPH in males.