The Selective T3 Sympathicotomy in Patients with Essential Palmar Hyperhidrosis

본태성 수장부 다한증 환자에서 선택적인 T3 교감신경 차단술

Objectives : In general, conventional T2, T3 thoracoscopic sympathicotomy must be one of the most effective treatments for the essential palmar hyperhidrosis. However, this is offset by the occurrence of a high rate of side effects, such as embarrassing compensatory sweating and Hornor's syndrome. The authors have performed a selective T3 thoracoscopic sympathicotomy to our patients to see whether it provides successful results with less side effects. Its preliminary results were compared with those of conventional T2, T3 thoracoscopic sympathicotomy. Methods : The thoracoscopic sympathicotomy was performed in 54 patients suffering from essential palmar hyperhidrosis. Twenty-four patients underwent a conventional sympathicotmy(group A) from Jan 1997 to Dec 1997 and 30 patients a selective T3 sympathicotmy(group B) from Jan 1998 to Dec 1999. For assessment of postoperative success and of complications all patients charts were reviewed. Patients further received a postal questionnaire regarding long-term effect, satisfaction, and side-effects. Results : No recurrence was observed in both groups. The global rate of compensatory sweating was significantly(p ＝0.020) different in both groups : 11 patients(45.8%) in group A and 5 patients(16.73%) in group B. The Hornor's syndrome was observed only in 4 patients in group A. The preliminary results of the procedure in group A were considered fully-satisfying by 16 patients(66.6%), 6 patients(25%) were satisfied partially, and only 2 patients(8.3%) were dissatisfied, and those of the procedure in group B satisfying by 26 patients(86.6%), 4 patients(13.3.% ) were satisfied partially, and none dissatisfied. Conclusion : The selective T3 sympathicotomy results in a significant decrease in the rate of disturbing side effects comparing to conventional T2, T3 sympathicotomy and it dose not lead to recurrence. Our results contribute to recommendations of a selective T3 thoracoscopic sympathicotomy as treatment of choice in essential palmar hyperhidrosis.