手掌多汗症に対する胸腔鏡下交感神経遮断術

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  • Thoracoscopic sympathectomy for palmar hyperhidrosis.

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Palmar hyperhidrosis, the etiology of which is unclear, is an embarrassing disorder especially for younger persons. Although open thoracic surgery for palmar hyperhidrosis has been described, its clinical application has been rare due to its invasiveness. Recent developments in endoscopic surgery have made the procedure to be reliable, safe and minimally invasive. The purpose of this paper is to report our clinical procedures and outcome. During the period between July 1997 and January 1999, 75 patients (36 males, 39 females) suffering from palmar hyperhidrosis underwent sequential bilateral thoracoscopic sympathectomy (Th 2-4) at our institution. Under general anesthesia in the semi-Fowler position, two small holes were made at the axilla. The invasiveness of this procedure, including cosmetic factor, has decreased according to the caliber of the thoracoscope. The main symptom of palmar hyperhidrosis dramatically resolved with a high improvement ratio (99.3%), and also that of sole hyperhidrosis is 54.7%. Compensatory sweating, which is the most troublesome complication of the procedure, occurred in 64% of the patients. Neuralgia and pen-operative bleeding were relatively common complications but there was no mortality or Horner's syndrome. Many patients were highly satisfied with this procedure, with the satisfactory score reaching 93.2 points out of 100.

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