Endoscopic Thoracic Sympathetic Block by Clipping for Adolescents with Recurrent Palmar Hyperhidrosis

Background and purpose: Endoscopic thoracic sympathectomy is a standard treatment for palmar hyperhidrosis, but postoperative complications may be troublesome. In addition, symptoms can recur after sympathectomy. Methods: Between January 1998 and November 2002, 14 patients with recurrent palmar hyperhidrosis underwent video-assisted thoracoscopic sympathetic block by clipping. All patients (5 males, 9 females; mean age 15.1 years, range 12-17 years) were placed in a semi-sitting position under single-lumen intubated anesthesia. Pulse oximeters and temperature monitors were placed on patients' palms. For patients with an intact T2 ganglion, T2 sympathetic block was performed by clipping between the second and third intercostal spaces using an 8 mm, 0° thoracoscope. A T3 block at the third and fourth intercostal spaces was performed if the patient had either a previous T2 sympathectomy or elevated palmar temperature of less than 1°C after T2 block. Results: The mean operation time was 30 minutes (range, 20-45 minutes). The level of sympathetic block was T2 and T3 in 5 patients, T2 in 3 patients, and T3 in 6 patients. Palmar hyperhidrosis improved in all patients. Of the 14 patients, 11 (84.6%) developed compensatory sweating of the trunk and lower limbs. One patient preferred his original sweating pattern; he received a reverse procedure 21 days after the original procedure and obtained improvement 2 days after removal of all clips. Among all patients, there were no surgical complications or mortality. Patients were discharged on the operative day or the first postoperative day. All patients maintained improvement of palmar hyperhidrosis without recurrence (mean 35.1 months of follow-up, range 12-58 months). Conclusion: Endoscopic thoracic T2 (with or without T3) sympathetic block by clipping is a safe and effective method for treating adolescents with recurrent palmar hyperhidrosis. Postoperative compensatory sweating or dry hands may be improved by removal of all clips.

並列關鍵字

palmar hyperhidrosis ； sympathetic block ； endoscopic thoracic sympathectomy

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