• 건강소식
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• v.30 no.8 s.333
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• pp.24-25
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• 2006

다한증이란 우리 몸이 체온 조절에 필요한 땀의 양보다 많은 양의 땀이 과다하게 분비되는 상태를 말한다. 일부에서는 당뇨병, 갑상선 기능항진증, 두부 손상 등의 원인에 의한 이차적인 증상으로 나타나는 경우도 있으나, 대개 뚜렷한 원인이 없는 건강한 상태에서 나타나는데 이러한 경우를 '본태성 다한증'이라고 한다. 본태성 다한증은 주로 손바닥과 발바닥에서 과다하게 땀이 나는 것으로, 심한 경우 겨드랑이 및 얼굴에도 땀이 많이 날 수 있다.

• Journal of Chest Surgery
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• v.35 no.2
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• pp.127-132
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• 2002

Video-assisted thoracic sympathicotomy is a safe and effective therapy for the treatment of essential hyperhidrosis with immediate symptomatic improvement. However, this is offset by the occurrence of a high rate of side effects, such as embarrassing compensatory hyperhidrosis. Therefore, by comparing and assessing the degree of symptomatic improvement or compensatory sweating following sympathicotomy at various levels and the extent of block, we are to determine the optimal level of sympathicotomy and which method will result in minimal side effects and maximal benefits. Material and Method: From January 1998 to June 2001, the thoracoscopic sympathicotomy was performed in 150 patients suffering from essential hyperhidrosis in the Dept. of Thoracic and Cardiovascular Surgery, Wonkwang University Hospital. The patients were divided into three groups. GroupI(n=50): patients having undergone 72,3,4 sympathicotomy, GroupII (n=50): patients having undergone 72 sympathicotomy which consist of blocking the interganglionic neural fiber on the second rib, and group 111(n=50): patients having undergone 73 sympathicotomy which consist of blocking the interganglionic neural fiber on the third rib. The parameters were composed of the satisfaction rate of treatment, the degree of compensatory sweating, postoperative complications, and changes of plantar sweating. Results: There was no difference in age and sex among the groups. All of the treated patients obtained satisfactory alleviation of essential hyperhidrosis in immediate postoperative period. However the rate of long-term satisfaction were 80%, 92%, and 96% in groupsI,II, and III respectively(p<0.05). More than embarrassing compensatory hyperhidrosis was present in 50%, 28%, and 18% in groups I,II ,and III respectively(p<0.05). Slight but comfortable amounts of palmar humidness was expressed in decreasing order, group III(34%), groupII(6%), and group I(4%) respectively(p<0.05). In regard to plantar sweating, decrease in sweating was expressed in each of the three groups, but was not significant between the groups.

• Proceedings of the KTCVS Conference
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• 1996.10a
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• pp.88-88
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• 1996

• Journal of Chest Surgery
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• v.31 no.3
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• pp.226-232
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• 1998

With recent advancements in the instrumentation and technique of VATS, it has become the method of choice to cure facial hyperhidrosis. From July 1996 to April 1997, we performed 43 thoracic lower stellate ganglionectomy with VATS for facial hyperhidrosis. There were 33 men and 10 women whose ages ranged from 17 to 63 years(mean age, 37 years). Of those patients, 23 complained only of facial hyperhidrosis, and 20 complained of facial hyperhidrosis along with excessive sweating of the palm or foot. Thoracoscopic sympathetic ganglionectomy procedures included lower stellate ganglionectomy in 12 patients; lower stellate ganglionectomy and T2-sympathetic ganglionectomy in 28 patients; and lower stellate, T2 and T3 sympathetic ganglionectomy in 3 patients. Common complications were compensatory hyperhidrosis(36 patients) and causalgia(8 patients). At the end of the follow-up period(minimum, 3 months) ninety-five percent of the patients reported satisfactory results. Thoracic lower stellate ganglionectomy with VATS is an efficient, safe and minimally invasive surgical procedure for facial hyperhidrosis.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.519-524
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• 1998

From January 1996 to December 1996, we performed 137 thoracic sympathetic ganglionectomies with VATs for primary hyperhidrosis in the department of thoracic and cardiovascular surgery at Anam hospital, Korea university medical center. There were 83 men and 54 women whose ages ranged from 13 to 63 years old(mean age: 25years). Of these patients, 128 patients had complained of palmar hyperhidrosis and 26 of facial hyperhidrosis. Thoracoscopic sympathetic ganglionectomies procedures included lower 1/3 Stellate ganglionectomies in 4 patients; lower 1/3 Stellate ganglionectomies and T2-sympathetic ganglionectomies in 18 patients; T2-sympathetic ganglionectomies in 86 patients; T2 and T3 sympathetic ganglionectomies in 10 patients; and T2, T3 and T4 sympathetic ganglionectomies in 19 patients. The mean operating time was 59 minutes(range: 25 to 162 minutes), and the mean hospital stay was 3.8 days(range: 2 to 8 days). Common complications were compensatory hyperhidrosis(109 patients) and causalgia(18 patients). At the end of the follow-up period(mean: 8 months) ninety-seven percent of the patients reported satisfactory results. Thoracic sympathetic ganglionectomy with VATs is an efficient, safe, and minimally invasive surgical procedure for primary hyperhidrosis.

• Journal of Chest Surgery
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• v.37 no.1
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• pp.64-71
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• 2004

Background: Video-assisted sympathicotomy is a safe and effective method for the treatment of essential hyperhidrosis with immediate symptomatic improvement. However, this is offset by the occurrence of a high rate of side-effects, such as embarrassing compensatory hyperhidrosis. Therefore, by comparing and assessing the relationship between temperature change measured by DITI (digital infrared thermographic imaging) and clinical results according to the level and extent of sympathicotomy in essential hyperhidrosis. we tried to obtain a more precisely and objectively, the distribution and degree of compensatory sweating by DITI and also for ascertaining the clinical usefulness. Material and Method: From January 2000 to June 2002, the thoracoscopic sympathicotomy was performed in 28 patients suffering from essential hyperhidrosis in Dept. of Thoracic and Cardiovascular Surgery, Wonkwang University Hospital. The patients were divided into four groups, Group I: patients having undergone T2 sympathicotomy, Group II: patients having undergone T3 sympathicotomy, Group III: patients having undergone T3,4 sympathicotomy, and Group IV: patients having undergone T2,3,4 sympathicotomy. The parameters were composed of the satisfaction rate of treatment, the degree of compensatory and plantar sweating, and temperature changes of entire body measured by DITI Result: There was no difference in age and follow-up period among the groups. All of the treated patients obtained satisfactory alleviation of essential hyperhidrosis in immediate postoperative period. However, the rate of long-term satisfaction were 85.8%, 85.8%, 42.9%, and 28.6% in group I, II, III, and IV (p<0.05). More than embarrassing compensatory sweating was present in 14.2%, 14.2%, 57.1%, 71.4% in group I, II, III, and IV (p<0.05) In regard to plantar sweating, decrease in sweating was expressed in each of four groups, but was not significant between groups. An apparent increase of temperature measured by DITI indicated sufficient denervation and predicted long-lasting relief of essential hyperhidrosis and also decrease in temperature of trunk and lower extremity by DITI had correlated well with postoperative satisfaction, and also postoperative compensatory sweating. Conclusion: We suggested that the incidence and degree of compensatory sweating was closely related to the site and the extent of thoracic sympathicotomy. Resection of the lower interganglionic neural fiber of the second thoracic sympathetic ganglion on the third rib is the most practical and minimally invasive treatment than other surgical methods. We were also to anticipated the distribution and degree of compensatory sweating by DITI precisely and objectively and for ascertaining the clinical usefulness.

• Journal of Chest Surgery
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• v.32 no.9
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• pp.818-822
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• 1999

Background: Thoracoscopic T2 sympathicotomy had been performed as a simple and effective method in treating palmar hyperhidrosis, however, this method had the complications of compensatory hyperhidrosis and facial anhidrosis. Therefore, a more limited and modified methods for T2 sympathicotomies were introduced and comparative analysis of the modified upper and lower T2 sympathicotomy were made in the treatment of palmar hyperhidrosis. Material and Method: From January 1997 to December 1998, 41 patients with palmar hyperhidrosis had been treated by modified T2 sympathicotomy at the Kon-Kuk University Seoul Hospital. Twenty-four patients underwent a modified upper T2 sympathicotomy(Group A), and seventeen patients underwent a modified lower sympathicotomy(Group B). A comparison between groups A and B were made according to the medical records and interview results. Result: All patients showed symptomatic improvements after the operation. The anisocoria, facial anhidrosis and dissatisfaction for compensatory hyperhidrosis were more common in Group A and the individual satisfaction for the operations were higher in Group B. Conclusion: The modified lower T2 sympathicotomy might be a more effective and less complicated method than the modified upper T2 sympathicotomy.

• Journal of Chest Surgery
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• v.36 no.3
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• pp.182-188
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• 2003

Background: Although ramicotomy (division of the rami communicantes of the thoracic sympathetic ganglia) is a selective and physiological surgical method for essential hyperhidrosis, it has some problems such as higher recurrence rates and the different surgical results among the patients and between left and right sides in the same individual. As one of the factors that are related to the differences in surgical result and recurrences, we investigated the anatomical variations of the rami communicantes. The purpose of this study is to help develop new surgical methods to decrease surgical differences among the patients or between the left and right sides of the same individual and recurrence rates in the clinical application of ramicotomy. Material and Method: We dissected 118 thoracic sympathetic chains in 59 adult Korean cadavers (male: 33, female: 26) to examine the anatomical variations of the rami communicantes from the second to the fourth thoracic sympathetic ganglia that have major components innervating to the hands. After the dissection of bilateral thoracic sympathetic chains, we compared the anatomy of left and right sides and examined the anatomical variations of rami communicantes. Result: The number and variation of communicating rami connecting the spinal nerves and the second sympathetic thoracic ganglion were much larger than lower levels. There was considerably less variability in the anatomy of the rami communicantes at successive levels. Among the 59 cadavers dissected, only 14.3% (9/59) had similar anatomy of thoracic sympathetic chains at both sides. As the components related to the essential palmar hyperhidrosis, intrathoracic nerve of Kuntz from the second thoracic sympathetic ganglion to the first intercostal nerve or brachial plexus were observed in 55.9% (66/118). The incidence of descending rami communicates from the second thoracic sympathetic ganglion to the third intercostal nerve and from the third thoracic sympathetic ganglion to the fourth intercostal nerve were 49.2% (58/118) and 28.0% (33/118). And the incidence of ascending rami communicates from the third thoracic sympathetic ganglion to the second intercostal nerve and from the fourth thoracic sympathetic ganglion to the third intercostal nerve were 6.8% (8/118) and 3.4% (4/118), respectively. Conclusion: Based on the various anatomical evidences of the rami communicantes from this study, only the ramicotomy at the third sympathetic ganglion level is insufficient for the treatment of the essential palmar hyperhidrosis to decrease the difference of surgical results and recurrences. When one is planning to perform the ramicotomy for the essential palmar hyperhidrosis, it is advantageous to divide the intrathoracic nerve of Kuntz on the second rib and the descending or ascending rami communicantes on the third and the fourth ribs as well as all the communicating rami from the third sympathetic ganglion.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1105-1110
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• 1997

Essential hyperhidrosis is a condition with excessive sweating, which may be localized in any part of the body Excessive sweating has a strong negative impact on the qual ty of life for many persons. From June 1992 to May 1996, 211 cases of thoracoscopic thoracic sympathectomy were performed in the Department of Thoracic Surgery, Yongdong Severance Hospital, Seoul, Korea. Among the 211 cases, 192 patients had palmar hyperhidrosis, and 19 cases had facial hyperhidrosis. There were 121 males and 90 (tamales, and the ages ranged from 10 to 67 years(average: 24.82 years old). The average operation time and the average postoperative hospital stay were 91.94 minutes and 4.31 days, respectively. Perioperative courses were uneventful, and all the patients had immediate and complete relief of symptoms with mild compensatory sweating on the chest wall and the back. Even though a thoracoscopy has the possibility of emergency conversion to a thoracotomy and technical difficulties still exist, especially in patients with facial hyperhidrosis, our experience indicates that video-assisted thoracoscopic thoracic sympathectomy is a very safe and useful procedure for h perhidrosis.

• Journal of Korean Neurosurgical Society
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• v.30 no.4
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• pp.486-492
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• 2001

Objective : Essential hyperhidrosis is a pathological condition of excessive sweating beyond that required to cool the body, though poorly understood, originating from a dysfunction of the sympathetic nervous system. Thoracoscopic sympathectomy is the most popular treatment for upper limb hyperhidrosis, because it is a safe, effective, minimally invasive, and time-saving method. However, the common complication is the compensatory hyperhidrosis in other areas of the body, notably on the back, chest, abdomen, and buttocks. Compensatory hyperhidrosis is severe enough for some people, especially those living in a warm climate or engaging in heavy physical activities, to regret ever having had operation. The pathophysiological mechanisms underlying compensatory hyperhidrosis are incompletely understood, even though it is thought to be a truly compensatory feature related to thermoregulation of the body. Materials and Methods : we studied the clinical features of total 233 patients who were diagnosed as essential hyperhidrosis and treated with thoracoscopic sympathectomy or sympathicotomy from March 1992 to July 2000. Results : The success rate of thoracoscopic sympathetic surgery(sympathectomy or sympathicotomy) was 98.7%. The global rate of compensatory hyperhidrosis was 77% ; 84% in group T2, 3 sympathectomy, 76% in group T2 sympathectomy, 43% in group T2, 3 sympathicotomy and 59% in group T2 sympathicotomy. The rate of embarrassing or disabling compensatory sweating was significantly higher in T2 sympathectomy and in T2, 3 sympathectomy than in T2 sympathicotomy and T2, 3 sympathicotomy with significancy in statistic analysis(p<0.01). The precipitating factors of compensatory hiperhidrosis, including heat(warm weather), anxiety, stress, and exertion were noted. The compensatory hyperhidrosis was the main cause of patient dissatisfaction after thoracoscopic sympathectomy. Conclusion : The degree of compensatory hyperhidrosis is closely related to the extent of thoracic sympathectomy.