Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Intermediate Term Follow Up for R3 Sympathicotomy in Palmar Hyperhidrosis

수장부 다한증에서의 제3번 늑골 위 교감 신경(R3) 차단술의 중기 결과

  • 손국희 (인하대학교 의과대학 흉부외과학교실) ;
  • 김광호 (인하대학교 의과대학 흉부외과학교) ;
  • 백완기 (인하대학교 의과대학 흉부외과학교) ;
  • 김정택 (인하대학교 의과대학 흉부외과학교) ;
  • 김현태 (인하대학교 의과대학 흉부외과학교) ;
  • 김영삼 (인하대학교 의과대학 흉부외과학교) ;
  • 윤용한 (인하대학교 의과대학 흉부외과학교실)
  • Published : 2004.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Thoracoscopic R3 (above the third rib)sympathicotomy has been performed as an effective method in treating palmar hyperhidrosis because it is effective in eliminating the symptoms of hyperhidrosis and has lower degree of compensatory hyperhidrosis than that of sympathectomy. Most of the results published were based on the short-term follow up. So we evaluated the intermediate term follow up results of the R3 sympathicotomy. Material and Method: From April 1999 to August 2001, ninety-four patients with palmar hyperhidrosis had been treated by R3 sympathicotomy at the Inha University Hospital. Follow-up study was completed for 76 patients (male 38, female 38) and average follow-up period were 25$\pm$9.1 (15∼50) months. The sympathetic trunk passing above the upper border of third rib was divided by electric cautery. The patient's satisfaction after surgery was estimated using the analogue scale from score 0 to 100 (100 means perfect satisfaction). Result. The scale of patient's satisfaction immediately after operation was 92.36$\pm$9.93. After 15 months, the scale of satisfaction was decreased to average 71.80$\pm$20.24 and it is statiscally significant. The cause of dissatisfaction were compensatory hyper-hidrosis and recurrence of symptom. The degree of sweating immediately after operation was mean 0 and after 15 months it increased to mean 1.5. The degree of the compensatory hyperhidrosis immediately after operation was mean 1 and it increased to mean 5 after 15 months. Conclusion: R3 sympathicotomy has excellent therapeutic results immediately after operation but therapeutic effectiveness is becoming to decrease 15 months after operation. The common causes of dissatisfaction are compensatory hyperhidrosis and recurrence of hyperhidrosis.

배경: 수부 다한증을 치료하기 위해 시행하는 제3번 늑골 위 교감신경 차단술의 경우 다한증 치료 효과는 교감신경 절제술과 유사하면서 보상성 다한증의 발생이 교감신경절제술보다 적다는 연구결과들이 많이 있으나 대부분 단기 결과이며 중기 추적 결과가 발표되어 있지 않아 제3번 늑골 위 교감신경 차단술의 중기 추적을 시행하였다. 대상 및 방법: 인하대학병원 흉부외과에서 99년 4월부터 2001년 8월까지 제3번 늑골 위 교감신경 차단술을 시행한 환자 94명 중 설문조사가 가능했던 76명(남자 38명, 여자 38명)을 대상으로 전화 설문을 시행하여 평균 25$\pm$9.1개월 간(15∼50개월)의 중기 결과를 추적하였다. 교감신경은 3번째 늑골 상방에서 절단하였다. 환자들의 만족도를 알기 위하여 linear analogue scale을 사용하였다 (100: 가장 만족함). 결과: 수술 후 만족도에 관한 질문에서 100점 만점 기준일 때 수술 직후 만족도가 92.36$\pm$9.93 인데 비해 수술 후 15개월에는 7l.80$\pm$20.24로 만족도가 감소하였으며(p<0.001) 이러한 만족도 감소의 이유는 보상성 다한증과 증상 재발 때문이었다. 땀나는 정도도 수술 직후 중앙값 0에서 15개월 후 중앙값 1.5로 증가하였다. 보상성 다한증의 경우 수술 직후 중앙값 1에서 수술 15개월 후 5로 증가하였다. 결론: 이와 같은 결과로 제3번 늑골 위 교감 신경 차단술의 경우 수술 직후에는 훌륭한 치료 효과를 보이나 수술 15개월 후에는 치료효과가 점차 감소한다. 불만족의 가장 흔한 이유는 보상성 다한증과 다한증의 재발이다.

Keywords

References

  1. Dis Chest v.20 The endoscopic approach to the vegatative nervous system and its therapeutic possibilities Kux,E. https://doi.org/10.1378/chest.20.2.139
  2. Cardiovasc Surg v.4 Hyperhidrosis treated by thoracoscopic sympathicotomy Drott,C.;Claes,G. https://doi.org/10.1016/S0967-2109(96)00048-8
  3. Korean J Thorac Cardiovasc Surg v.32 Thoracoscopic T3 sympathicotomy for palmar hyperhidrosis Kim,K.T.;Kim,I.H.;Lee,S.A.;Baek,M.J.;Sun,K.;Kim,H.M.
  4. Korean J Thorac Cardiovasc Surg v.32 According to extent of sympathectomy, compensatory hyperhidrosis in essential hyperhidrosis Lee,D.H.;Yoon,Y.H.;Kim,H.K.;Kang,J.S.;Lee,K.J.;Shim,K.W.
  5. Korean J Thorac Cardiovasc Surg v.35 Tendency of Compensatory Hyperhidrosis after Sympathicotomy in Essential Hyperhidrosis Lee,J.H.;Park,K.S.;Park,C.K.;Yoo,Y.S.;Lee,K.S.;Choi,S.Y.
  6. Korean J Thorac Cardiovasc Surg v.35 Clinical results according to the level and extent of sympathicotomy in essectial hyperhidrosis Choi,S.H.;Park,J.P.;Lee,S.Y.
  7. Am J Surg v.181 Microinvasive video-assisted thoracoscopic sympathicotomy for primary palmar hyperhidrosis Kim,B.Y.;Oh,B.S.;Park,Y.K.;Jang,W.C.;Suh,H.J.;Im,Y.H. https://doi.org/10.1016/S0002-9610(01)00627-4
  8. Lancet v.351 Compensatory hyperhidrosis after thoracic sympathectomy Adar,R. https://doi.org/10.1016/S0140-6736(05)78277-5
  9. N Engl J Med v.263 Compensatory hyperhidrosis of sympathectomy Shelly,W.B.;Florence,R. https://doi.org/10.1056/NEJM196011242632105
  10. Ann Thorac Surg v.64 Thoracoscopic sympathectomy for upper limb hyperhidrosis: Looking for the right operation Gossort,D.;Toledo,L.;Fristsch,S.(et al.) https://doi.org/10.1016/S0003-4975(97)00799-6
  11. Korean J Thorac Cardiovasc Surg v.32 Hyperhidrosis treated by thoracoscopic sympathicotomy Yoon,Y.H.;Lee,D.H.;Kim,H.K.;Lee,K.J.;Shin,H.K.;Kang,J.S.
  12. Ann Thorac Surg v.68 Video assistance reduces complication rate of thoracoscopic sympathicotomy for hyperhidrosis Zacherl,J.;Imhof,M.;Huber,E.R.(et al.) https://doi.org/10.1016/S0003-4975(99)00718-3
  13. Minimally Invas Ther Allied Technol v.5 Compensatory sweating: An avoidable complication of thoracoscopic sympathectomy? Rennie,J.A.
  14. Eur J Surg Suppl v.572 Present and future trends in thoracoscopic sypathectomy Hederman,W.P.
  15. Surg Laparosc Endosc Percutan Tech v.10 Endoscopic thoracic sympathectomy for treatment of essential hyperhidrosis syndrome: experience with 650 patients Reisfeld,R.;Nguyen,R.;Pnini,A.
  16. J Vasc Surg v.37 Endoscopic transthoracic sympathectomy for upper limb hyperhidrosis: Limited sympathectomy does not reduce postoperative compensatory sweating Leseche,G.;Castier,Y.;Thabut,G.(et al.) https://doi.org/10.1067/mva.2002.23
  17. Ann Chir Gyn v.90 Lin-Telaranta classification : The importance of different procedure for different indications in sympathetic surgery Lin,C.C.;Telaranta,T.
  18. Surg Endosc Limited endoscopic thoracic sympathectic block for hyperhidrosis of the upper limb: reduction of compensatory sweating by clippint T4 Neumayer,C.;Zacherl,J.;Holak,G.(et al.)
  19. J Thorac Cardiovasc Surg v.123 Anatomical variations of the T2 nerve root (incluing nerve of Kuntz) and their implications for symapthectomy Chung,I.H.;Oh,C.S.;Koh,K.S.;Kim,H.J. https://doi.org/10.1067/mtc.2002.119340
  20. Ann Acad Med Singapore v.25 Minimally invasive surgery: video endoscopic thoracic sympathectomy for palmar hyperhidrosis Kao,M.C.;Lin,J.Y.;Chen,Y.L.;Hshieh,C.S.;Cheng,L.C.;Huang,S.J.
  21. Ann Surg v.220 Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs-A critical analysis and long term results of 430 operations Herbst,F.;Plas,E.G.;Fuger,R.;Fritsch,A. https://doi.org/10.1097/00000658-199407000-00012
  22. Korean J Thorac Cardiovasc Surg v.30 Reoporation of essential hyperhidrosis Cho,H.M.;Lee,D.H.;Kim,H.K.
  23. Mayo Clin Proc v.78 Sympathotomy instead of sympathectomy for palmar hyperhidrosis : Minimizing postoperative compensatory hyperhidrosis Atkinson,J.L.D.;Fealey,R.D. https://doi.org/10.4065/78.2.167