单腔气管插管单孔微切口胸腔镜下R3 交感神经切断术治疗手汗症65例

Thoracoscopic R3 sympathectomy with a single mini incision in the single lumen endotracheal intubation for 65 cases of palmar hyperhidrosis

摘要:

目的 总结单腔气管插管单孔微切口法胸腔镜R3交感神经切断术治疗手汗症的临床经验。方法 分析2012年1月-2013年6月，单腔气管插管单孔微切口胸腔镜R3交感神经切断术治疗手汗症65例的临床资料。单腔气管插管全身麻醉下（非人工气胸），患者体位呈75°半坐卧位。女性患者采取第3肋间乳腺外缘腋下切口，男性选择乳晕切口（瘦长型）或腋前线胸大肌外侧缘第3肋间（肥胖型）切口，切口长约0.8 cm，均采用电凝钩切断R3（rib levels）交感神经及可能的交通支。结果 65例患者单孔腔镜下手术均获得成功，双侧平均手术时间21 min（15～35）min，术后平均住院时间1.1 d（1～2）d，平均随访时间6.2个月（1～14）个月，全组无严重并发症，术后并发右侧少量气胸2例（约15%），术后轻度代偿性多汗12例（18.5%），无复发病例。所有患者术后均表示满意。结论 单腔气管插管（非人工气胸）单孔微切口电视胸腔镜交感神经切断术治疗手汗症，采用电凝钩与30°腔镜从同一切口进入胸腔，能够较好观测术野并操作电凝钩切断交感神经，定位准确，安全有效，并发症少，切口隐蔽美观，符合美学要求，单腔气管插管降低麻醉成本及术中管理难度。可在临床中推广应用。

Abstract:

【Objective】 To summarize the clinical experience of thoracoscopic R3 sympathectomy with a single mini incision in the single lumen endotracheal intubation for palmar hyperhidrosis. 【Methods】 From January 2012 to June 2013, 65 cases of primary hyperhidrosis patients were treated by thoracoscopic R3 sympathectomy with a single mini incision in the single lumen endotracheal intubation. A single lumen endotracheal intubation (non artificial pneumothorax).The patient was 75° semireclining position. The subaxillary small incision at the outer edge of mammary glands at 3rd intercostal were selected on female patients. The periareolar incision was selected on lanky man, while the incision at the outer edge of pectoralis at 3rd intercostal was selected on obesity man. 【Results】 65 cases of operations were successful without serious complications. The operation time (both sides) was 21 (15~35) min. The average postoperative hospital stay was 1.1(1~2) d. The mean follow-up was 6.2(1~14) months. Right pneumothorax (about 15%) in 2 cases, mild compensatory sweating (18.5%) in 12 cases, Postoperative follow-up showed no recurrence. Patients were satisfied. 【Conclusion】 Electric coagulation hook and 30°mirror from the same incision into the chest can obtain good vision and complete thoracic sympathectomy. This operation mode can be accurate positioning, safe and effective, less complications, concealing incision, in line with the requirements ofaesthetic. A single lumen endotracheal intubation anesthesia management was less cost and reduce the difficulty in operation,which can be worthy of clinical application.