超微8.0 mm单孔胸腔镜经乳晕切口神经切断术治疗原发性手汗症的疗效分析

Analysis of the therapeutic effect of ultra-micro 8.0 mm single-port thoracoscopic nerve resection through areola incision for the treatment of primary palmar hyperhidrosis

摘要:

目的 探究超微8.0 mm单孔胸腔镜经乳晕切口神经切断术治疗原发性手汗症（PPH）的临床疗效。方法 选取2018年1月－2022年1月该院收治的PPH患者84例，随机分为观察组［经乳晕入路（IMA）组］和对照组［腋下入路（AA）组］，各42例。观察组采取超微8.0 mm IMA单孔胸腔镜交感神经切断术（ETS），对照组采取传统AA单孔ETS。比较两组患者视觉模拟评分法（VAS）评分、炎症因子［血清C反应蛋白（CRP）、皮质醇（Cor）和白细胞介素-6（IL-6）］、术后切口美容效果和代偿性出汗情况。结果 与对照组相比，观察组术后各时点（术后2、12和24 h）的VAS评分明显降低，差异均有统计学意义（P < 0.05）；术后12和24 h，两组患者CPR、Cor和IL-6水平明显高于术前，但观察组明显低于对照组，差异均有统计学意义（P < 0.05）；与对照组相比，观察组术后切口美容总满意率明显提高，差异有统计学意义（P < 0.05）；两组患者术后代偿性多汗发生率比较，差异无统计学意义（P > 0.05）。结论 超微8.0 mm IMA单孔ETS治疗PPH的临床疗效好，与传统AA单孔ETS相比，其具有创伤小、出血量少、患者痛苦轻、安全性高和患者满意度高等优势，值得临床推广应用。

Abstract:

Objective To explore the clinical efficacy of ultra-micro 8.0 mm single-port thoracoscopic nerve resection through areola incision in the treatment of primary palmar hyperhidrosis (PPH).Methods 84 patients with PPH from January 2018 to January 2022, were divided into the observed group [(inframammary approach, IMA) group, n = 42] and control group [axillary approach (AA) group, n = 42]. The observed group was treated with ultra-micro 8.0 mm IMA single-port endoscopic thoracic sympathectomy (ETS), the control group used the traditional AA single-port ETS. The visual analogue scale (VAS) score, serum C-reactive protein (CRP), cortisol (Cor), interleukin-6 (IL-6) levels, the postoperative cosmetic effect and compensatory hyperhidrosis of the two groups were compared.Results The VAS scores of 2, 12 and 24 h after surgery in the observation group were significantly lower than those of the control group, the differences were statistically significant (P < 0.05); At 12 and 24 h postoperation, the levels of CPR, Cor, and IL-6 levels in both groups of patients were significantly higher than preoperation, but those in the observation group were significantly lower than those of the control group, the differences were statistically significant (P < 0.05); The total satisfaction rate of postoperative incision in the observation group was significantly higher than that of the control group, the difference was statistically significant (P < 0.05); There was no statistically significant difference of the incidence of compensatory hyperhidrosis between the two groups (P > 0.05).Conclusion The clinical efficacy of ultra-micro 8.0 mm IMA single-port ETS through areola incision in the treatment of PPH is good. Compared with the traditional axillary single-port thoracoscopic method, it has the advantages of small trauma, less bleeding, less patient pain, high safety and high patient satisfaction. It is worthy of clinical promotion and application.