Endoscopic thoracic sympathicotomy for primary palmar hyperhidrosis: A retrospective multicenter study in China

Background: This study aimed to evaluate the clinical efficacy and safety of endoscopic thoracic sympathicotomy and to explore strategies to decrease the incidence of transfer hyperhidrosis (TH).Methods: From January 2003 to July 2016,10,275 patients with primary palmar hyperhidrosis underwent endoscopic thoracic sympathicotomy in 15 different institutions. We carried out a retrospective analysis of these patients who were grouped into group A, those with nonretained R2 (R2, R2-3, or R2-4 ablation), and group B, those with retained R2 (single R3 or R4 ablation).Results: All procedures were performed successfully. Both hands of all patients became warm and dry immediately after endoscopic thoracic sympathicotomy. Pneumothorax occurred in 146 patients, and 39 patients had intraoperative bleeding. Follow-up was carried out from 6 months to 13 years. A total of 531 patients (5.2%) were lost to follow-up. The effective rate for primary palmar hyperhidrosis was 100%. Palmar hyperhidrosis recurred in 73 patients (0.7%). Transfer hyperhidrosis appeared in 7,678 patients (78.8%). For groups A and B, the incidence of TH was 80.4% and 78.5%, respectively (P > .05), but the incidence of grade III+IV TH in group B (1.6%) was less than that in group A (4.8%; P < .001).Conclusion: Endoscopic thoracic sympathicotomy is a minimally invasive, safe, and effective therapeutic method for primary palmar hyperhidrosis. Although the overall incidence of TH is high, the incidence of grade III to IV TH can be decreased by reserving R2, lowering the level of thoracic sympathicotomy, and single severing of R3 or R4. (C) 2019 Elsevier Inc. All rights reserved.

背景：本研究旨在评估内镜下胸交感神经切断术的临床疗效和安全性，并探索降低转移性多汗症（TH）发生率的策略。 方法：2003年1月至2016年7月，15个不同机构的10275例原发性手掌多汗症患者接受了内镜下胸交感神经切断术。我们对这些患者进行了回顾性分析，将其分为A组（未保留R2，即R2、R2 - 3或R2 - 4消融）和B组（保留R2，即单纯R3或R4消融）。 结果：所有手术均成功完成。内镜下胸交感神经切断术后，所有患者的双手立即变得温暖干燥。146例患者发生气胸，39例患者术中出血。随访时间为6个月至13年。共有531例患者（5.2%）失访。原发性手掌多汗症的有效率为100%。73例患者（0.7%）手掌多汗症复发。7678例患者（78.8%）出现转移性多汗症。A组和B组的TH发生率分别为80.4%和78.5%（P>0.05），但B组Ⅲ + Ⅳ级TH的发生率（1.6%）低于A组（4.8%；P<0.001）。 结论：内镜下胸交感神经切断术是治疗原发性手掌多汗症的一种微创、安全且有效的治疗方法。尽管TH的总体发生率较高，但通过保留R2、降低胸交感神经切断水平以及单纯切断R3或R4，可降低Ⅲ - Ⅳ级TH的发生率。（C）2019爱思唯尔公司。保留所有权利。