Endoscopic thoracic sympathicotomy/sympathotomy (ETS) is the first-line treatment for palmar hyperhidrosis with best minimally invasive effect. In recent years, with the widespread development of ETS in the treatment of palmar hyperhidrosis, many medical centers list ETS surgery as the day surgery. Nevertheless, there is no expert consensus on medical quality control of day surgery for ETS yet. Therefore, the Chinese Medical Doctor Association Thoracic Surgeons Branch Hyperhidrosis Subcommittee, Sympathetic Neurosurgery Expert Committee of WU Jieping Medical Foundation, and Fujian Provincial Strait Medical and Health Exchange Association Hyperhidrosis Special Committee organized domestic experts to conduct repeated consultations and sufficient discussions based on domestic and foreign literatures, to formulate the "Chinese expert consensus on ETS optimization and surgical quality control of day surgery for palmar hyperhidrosis". It aims to provide a reference for the clinical diagnosis and treatment of palmar hyperhidrosis for thoracic surgery colleagues in our country, to enhance their management level and work efficiency, and ultimately to achieve standardized quality control.
ObjectiveTo evaluate the efficiency and clinical outcomes of endoscopic thoracic sympathectomy (ETS) with flexible thoracoscopy under local anesthesia with monitored anesthesia care in primary palmar hyperhidrosis. MethodsFrom March 2011 to March 2013, we performed ETS with flexible thoracoscopy under local anesthesia with monitored anesthesia in 23 patients with primary palmar hyperhidrosis (PH), including 10 males and 13 females with their age of 25.6±7.2 years (range, 17-32 years). T3 sympathectomy was performed with flexible endoscopy under local anesthesia with monitored anesthesia care. All patients were followed up until May 2014. ResultsDuring surgery, the vital signs of the patients remained stable. Operation time was 30-40 minites. The symptom of PH disappeared right in the surgery. All patients were discharged from the hospital on the 2nd postoperative day. One patient received unilateral sympathectomy because of pleural adhesion. Other 22 patients received follow-up to May 2014 and no reoccurrence was reported. ConclusionETS with flexible thoracoscopy under local anesthesia with monitored anesthesia is a safe, microinvasive and effective method.
ObjectiveTo investigate the feasibility and clinical outcomes of bilateral endoscopic thoracic sympathectomy (ETS) through single hole for palmar hyperhidrosis (PHH). MethodsFrom August 2012 to April 2013, 19 PHH patients were admitted in the Department of Thoracic Surgery, The Third People's Hospital of Chengdu. There were 7 male and 12 female patients with their age of 24.7(15-33) years. All the patients underwent bilateral ETS through single hole under general anesthesia. ResultsAll the operations were successfully performed. Average operation time was 28.4 minutes, and postoperative hospital stay was 1.6 days. Seventeen patients were followed up for 2 to 10 months. PHH symptoms all disappeared without Horner's syndrome or hemopneumothorax. ConclusionBilateral ETS through single hole is a minimally invasive, reliable and safe procedure for PHH with low morbidity.
ObjectiveTo investigate the clinical safety and feasibility of thoracic sympathectomy in the treatment of palmar hyperhidrosis based on ambulatory surgery.MethodsA retrospective analysis of 74 patients who underwent thoracoscopic sympathectomy in the Department of Thoracic Surgery of the First People's Hospital of Yunnan Province from January 2017 to April 2021 was performed, including 35 males and 39 females aged 12-38 (21.32±4.13) years. Patients were divided into two groups according to different treatments. There were 34 patients in a control group (adopting traditional surgery), and 40 patients in an observation group (adopting ambulatory surgery). The clinical effects of the two groups were compared.ResultsNo massive bleeding, conversion to thoracotomy, postoperative pneumothorax or severe pneumonia occured in all patients. Univariate analysis of intraoperative indexes showed that the two groups had no statistical difference in total hospitalization cost, operation time, anesthesia time or postoperative waiting time (P>0.05). The amount of intraoperative blood loss in the observation group was less than that in the control group (P<0.05). The time of postoperative out of bed and recovery of walking capacity and the incidence of electrolyte disturbance in the observation group were shorter or lower than those in the control group (P<0.05). There was no statistical difference in white blood count, neutrophils count or postoperative 24 h pulse oxygen saturation fluctuation peak between the two groups (P>0.05).ConclusionBased on the optimized diagnosis and treatment model, thoracoscopic sympathectomy with laryngeal mask airway which is performed during ambulatory surgery, is feasible and worth popularizing in thoracic surgery.
目的评价喉罩或单腔气管内插管在胸腔镜下胸交感神经链切断术的应用效果。 方法选择80例行胸腔镜下胸交感神经链切断术的手汗症患者，采用计算机随机法将患者分为A、B两组，每组各40例。其中A组男20例、女20例，平均年龄24岁；B组男21例、女19例，平均年龄23岁。A组使用喉罩通气，B组使用单腔气管内导管，均应用小潮气量较快频率正压通气及间歇人工气胸。观察两组麻醉期间各时点心率（HR）、平均动脉压（MAP）、呼气末二氧化碳分压（PetCO2）、动脉血氧饱和度（SpO2）、心电图（ECG）的变化。同时记录喉罩/单腔导管置入时间、CO2充气时间、手术时间、术中术后不良反应和并发症。 结果两组患者手术顺利，无并发症。A组喉罩/插管置入时间和喉罩/单腔管呛咳、术后咽喉疼痛发生率低于B组，差异有统计学意义（P<0.05）。B组MAP、HR水平在T2（喉罩/单腔管置入后）和T7（苏醒后拨喉罩/单腔管时）明显高于T1（麻醉诱导完成），差异有统计学意义（P<0.05）；A组MAP、HR水平在T2和T7时亦明显低于B组，差异有统计学意义（P<0.05）。所有患者术中ECG、SpO2和PetCO2无明显变化。 结论喉罩或单腔气管内插管结合间歇的人工气胸都能满足胸交感神经切断术的操作需要，喉罩具有更稳定的血流动力学状态和更高的安全性。
ObjectiveTo investigate the safety of endoscopic thoracic sympathicotomy in the treatment of primary hyperhidrosis based on ambulatory surgery mode.MethodsRetrospective analysis was performed on the clinical data of 158 patients with primary hyperhidrosis who received endoscopic thoracic sympathicotomy in the Affiliated Hospital of Zunyi Medical University from January 2019 to March 2021. There were 68 (43.2%) males and 90 (56.8%) females with an average age of 14-33 (20.5±3.1) years. The basic information of the patients, operation time, intraoperative blood loss, postoperative pain score, hospitalization expenses and postoperative complications were observed and recorded.ResultsAll surgeries were successfully completed and the patients were discharged as planned. The operation time was 41.8±13.9 min, the intraoperative blood loss was 10.5±7.3 mL, the postoperative anesthesia recovery time was 15.0±5.9 min, and the pain score was 3.0±0.9 points. The total length of hospitalization was 1.6±1.0 days. The total postoperative expenses were 9 471.7±1 698.9 yuan. Pneumothorax occurred after the operation in 3 patients. Telephone follow-up on the 30th day after the operation showed no recurrence of sweaty hands, pneumothorax or rapid heart rate, and no serious complications or death related to the day operation within 30 days after the operation.ConclusionEndoscopic thoracic sympathicotomy based on ambulatory surgery mode is safe and effective in the treatment of primary hyperhidrosis.
This guideline systematically reviewed and summarized the 20 years' clinical and basic research experience of minimally invasive treatment of palmar hyperhidrosis (PH) in China, and discussed the hot and difficult issues of minimally invasive treatment of PH. We have formed a new consensus of PH in terms of its definition, clinical manifestations, diagnostic criteria and classification, surgical indications and contraindications, surgical procedures and management of complications, especially in the area of postoperative compensatory hyperhidrosis (CH). This guideline confirmed that endoscopic thoracic sympathicotomy (ETS) was the most effective treatment for PH and that CH was the most common side effect. In order to reduce the incidence of CH, eliminate patient's distress and improve patient's satisfaction, the guideline emphasized that the keys to prevent CH were to pay attention to pre-operative interview, communicate with patients, select patients carefully, avoid the enlargement of operative indication and optimize operative procedure. This guideline also introduced the advantages and disadvantages of various methods to reduce the incidence of CH. We provided this authoritative guidance document in order to avoid the surgical risk, strengthen the perioperative management and improve the sugery effect.
Objective To summary the effects and prospects of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension. Methods Literatures which about the relationship between renal sympathetic nerves and hypertension， and the technical prospect and inadequacy of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension， were analyzed and reviewed. Results Hypertension， which as a seriously public health problem， was the focus of clinical treatment currently. Renal sympathetic nerve was certified playing an important role in regulation of blood pressure， and percutaneous radiofrequency catheter-based renal sympathetic denervation had potential superiority in the treatment of resistant hypertension. Conclusion Percutaneous radiofrequency catheter-based renal sympathetic denervation is an effective method for resistant hypertension.
ObjectiveTo review the progress of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension as well as the inadequacy, and to reevaluate the clinical significance of the technology. MethodsDomestic and foreign literatures were collected to summary the progress of percutaneous radiofrequency catheter-based renal sympathetic denervation in treatment of resistant hypertension. ResultsThe percutaneous radiofrequency catheter-based renal sympathetic denervation in the treatment of resistant hypertension had obtained some positive results recently, but the long-term outcomes and safety of the technology were still subjected to further evaluation. ConclusionThe effect of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension remains to be controversial, and both the equipment and technology of radiofrequency catheter-based ablation need to be improved.