Objective To explore the feasibility of using high-definition thoracoscopy to identify sympathetic ganglia during endoscopic thoracic sympathicotomy for primary palmar hyperhidrosis. MethodsThe clinical data of patients with primary palmar hyperhidrosis who underwent thoracoscopic sympathectomy in Taikang Xianlin Drum Tower Hospital from June to July 2023 were retrospectively analyzed. At the same time, the operation video of patients with previous fluorescent thoracoscopic surgery was retrospectively analyzed.Results Finally 100 patients were collected, including 54 females and 46 males, with an average age of 21.92±6.56 years. Five patients were intravenously administered with indocyanine green before operation. During operation, the rate of ganglion display was 92.5% (740/800), the rate of ganglion variation was 32.0% (237/740), and the improvement rate of hand sweat was 100.0% (100/100). In 5 patients with near-infrared fluorescence imaging, the coincidence rate between the ganglion identified under white light and the ganglion displayed by fluorescence was 100.0% (38/38). The display rate of ganglion under white light was 95.5% (107/112), and the display rate under near infrared fluorescence imaging was 96.4% (108/112), and the coincidence rate was 99.1% (107/108). Conclusion With the wide clinical application of high-definition thoracoscopy, accurate thoracic sympathectomy has the feasibility of clinical application.
ObjectiveTo investigate the clinical safety and feasibility of thoracic sympathectomy in the treatment of palmar hyperhidrosis based on ambulatory surgery.MethodsA retrospective analysis of 74 patients who underwent thoracoscopic sympathectomy in the Department of Thoracic Surgery of the First People's Hospital of Yunnan Province from January 2017 to April 2021 was performed, including 35 males and 39 females aged 12-38 (21.32±4.13) years. Patients were divided into two groups according to different treatments. There were 34 patients in a control group (adopting traditional surgery), and 40 patients in an observation group (adopting ambulatory surgery). The clinical effects of the two groups were compared.ResultsNo massive bleeding, conversion to thoracotomy, postoperative pneumothorax or severe pneumonia occured in all patients. Univariate analysis of intraoperative indexes showed that the two groups had no statistical difference in total hospitalization cost, operation time, anesthesia time or postoperative waiting time (P>0.05). The amount of intraoperative blood loss in the observation group was less than that in the control group (P<0.05). The time of postoperative out of bed and recovery of walking capacity and the incidence of electrolyte disturbance in the observation group were shorter or lower than those in the control group (P<0.05). There was no statistical difference in white blood count, neutrophils count or postoperative 24 h pulse oxygen saturation fluctuation peak between the two groups (P>0.05).ConclusionBased on the optimized diagnosis and treatment model, thoracoscopic sympathectomy with laryngeal mask airway which is performed during ambulatory surgery, is feasible and worth popularizing in thoracic surgery.
ObjectiveTo explore the clinical effect of tubeless 3 mm ultra-fine thoracoscope combined with needle electrocoagulation hook thoracic sympathicotomy in the treatment of primary palmar hyperhidrosis. MethodsThe clinical data of 77 patients with primary palmar hyperhidrosis who underwent surgery in the First Hospital of Lanzhou University from September 2017 to July 2021 were retrospectively analyzed, including 50 males and 27 females, with an average age of 23.60±5.60 years. A total of 36 patients were treated with tubeless 3 mm ultra-fine thoracoscopic electrocoagulation hook thoracic sympathicotomy (an observation group), and 41 patients were treated with conventional thoracoscopic thoracic sympathicotomy (a control group). The baseline data, perioperative data and the results of 12 hours after operation were compared between the two groups. ResultsAll the 77 patients completed the operation successfully, no conversion to thoracotomy, no intraoperative bleeding, and no conversion to endotracheal intubation in the observation group. In the observation group, the time of anesthesia before operation [19.00 (17.00, 23.75) min vs. 25.00 (21.00, 27.00) min, P=0.001] and postoperative hospital stay [2.00 (1.00, 2.00) d vs. 2.00 (1.00, 3.00) d, P=0.012] were shorter than those in the control group. The operation time [22.50 (21.00, 25.75) min vs. 26.00 (23.50, 28.50) min, P=0.001], intraoperative blood loss [5.00 (2.25, 5.00) mL vs. 6.00 (5.00, 10.00) mL, P=0.003], postoperative pain index [2.00 (1.00, 2.00) vs. 3.00 (2.00, 3.00), P=0.001], hospitalization cost (14 246.58±879.28 yuan vs. 15 085.90±827.15 yuan, P<0.001) and postoperative inflammation index: white blood cell count [(12.96±2.32)×109/L vs. (14.47±2.05)×109/L, P=0.003], percentage of neutrophils (76.31%±5.40% vs. 79.97%±7.12%, P=0.014) were significantly lower or less than those in the control group. There was no significant difference in the incidence of major postoperative complications or adverse consequences between the two groups (P>0.05). In the evaluation of 12 hours after operation, the time of getting out of bed [2.00 (1.00, 2.00) h vs. 2.00 (2.00, 3.00) h, P=0.017], the time of drinking water after operation [1.50 (1.00, 2.00) h vs. 2.00 (1.00, 3.00) h, P=0.005], and the heart rate (80.25±14.42 bpm vs. 91.07±15.08 bpm, P=0.002), the incidence of dizziness, nausea and other uncomfortable symptoms (5.6% vs. 25.0%, P=0.040) at 12 hours after operation were shorter or lower than those in the control group. There was no significant difference in blood oxygen saturation (non-inhaled oxygen state) 12 hours after the operation between the two groups [97.00% (95.25%, 98.00%) vs. 97.00% (96.00%, 98.00%), P=0.763]. ConclusionCompared with conventional thoracoscopic thoracic sympathicotomy, tubeless 3 mm ultra-fine thoracoscopic electrocoagulation hook thoracic sympathicotomy can significantly shorten the operation time, reduce postoperative pain and promote postoperative recovery, in line with the concept of accelerated rehabilitation surgery and minimally invasive surgery, and is worth popularizing in clinical practice.
Objective To examine the relation between compensatory sweating（CS） and the resection site of the sympathetic nerve china during sympathectomy in treatment of palmal hyperhidrosis and thus to investigate the potential mechanism of the occurrence of compensatory sweating. Methods From October 2004 to December 2005, 128 patients with primary palmar hyperhidrosis were randomly divided into two groups： 61 with T3 sympathicectomy （T3 group） and 67 with T4 sympathicectomy （T4 group）. All were treated under general anesthesia, single lumen intubation and via intercostal mediastinoscopic surgery. Results No morbidity or mortality occurred. Sweating of target organs was cured in all cases. Rates of minor CS in Group T3 or T4 showed no statistically significant （χ^2 = 1.866, P = 0.122）. Rate of moderate CS in group T4 was significantly lower than that in group T3 （χ^2=7.618, P=0.006）. No severe CS occurred. Conclusion Occurrence rate and severity of compensatory sweating are lower in T4 resection than in T3.
ObjectiveTo review the progress of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension as well as the inadequacy, and to reevaluate the clinical significance of the technology. MethodsDomestic and foreign literatures were collected to summary the progress of percutaneous radiofrequency catheter-based renal sympathetic denervation in treatment of resistant hypertension. ResultsThe percutaneous radiofrequency catheter-based renal sympathetic denervation in the treatment of resistant hypertension had obtained some positive results recently, but the long-term outcomes and safety of the technology were still subjected to further evaluation. ConclusionThe effect of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension remains to be controversial, and both the equipment and technology of radiofrequency catheter-based ablation need to be improved.
ObjectiveTo analyze the safety and feasibility of the adhesion dissection in transaxillary uniportal thoracoscopy for palmar hyperhidrosis.MethodsData of 168 patients, including 77 males and 91 females with an average age of 14 - 41 (24.3±5.4) years, who received transaxillary uniportal video-assisted thoracoscopic surgery (VATS) for palmar hyperhidrosis from January 2015 to July 2018 were retrospectively analyzed. Severe adhesion was found in 4 patients and mild adhesion was found in 12 patients. Artificial pneumothorax was used to help dissect adhesion. Preoperative CT scan could help locate the rib according to the relative position to azygos vein or aotic arch.ResultsAll of 168 patients were successfully completed with transaxillary uniportal VATS. Then chest tubes were put in the 4 severe adhesion patients. The tube was removed from one patient after 11 days because of air leak, and from the other three patients on the next day. The other 164 patients with or without adhesion were discharged from hospital on the operation day or the next day.ConclusionAdhesion dissection in transaxillary uniportal VATS for palmar hyperhidrosis is safe and feasibile.
ObjectiveTo explore clinical outcomes of video-assisted thoracoscopic sympathectomy (VATS) for the treatment of palmar hyperhidrosis (PH), and compare the results between T2 segment surgery and T2-T3 segment surgery. MethodsFrom April 2009 to August 2012, 48 consecutive PH patients underwent single-port VATS in Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University. There were 18 male and 30 female patients with their age of 14-40 (22.1±5.4) years. According to different surgical procedures, all the patients were divided into T2 segment group (29 patients) and T2-T3 segment group (19 patients). Preoperative characteristics, surgical results and postoperative morbidity were compared between the 2 groups. ResultsPH symptoms disappeared after VATS in all the patients. Patients were followed up for 6-44(21.3±10.1)months, and 2 patients were lost in both T2 segment group and T2-T3 segment group. The incidence of postoperative compensatory sweating was 66.7% (18/29) in T2 segment group and 70.6% (12/19) in T2-T3 segment group. The incidence of moderate to severe compensatory sweating of T2 segment group was significantly higher than that of T2-T3 segment group (51.9% vs. 29.4%, P < 0.05). Twenty-six patients (96.3%) in T2 segment group and 16 patients (94.1%) in T2-T3 segment group were completely or partially satisfied with surgical results. ConclusionVATS is the only effective surgical procedure for the treatment of moderate to severe PH. Both T2 and T2-T3 segment sympathectomy can effectively reduce PH symptoms after VATS, but the incidence of postoperative compensatory sweating is high, which has negative influence on patients'satisfaction.
ObjectiveTo discuss the anesthetic procedure for left thoracic sympathectomy under thoracoscope for long QT syndrome patients. MethodsWe selected 8 patients with long QT syndrome classified American Society of Anesthesiologists Ⅱ-Ⅲ who were going to undergo left thoracic sympathectomy under thoracoscope between July 2011 and October 2014 as our study subjects. They were given a moderate amount of beta blockers before operation, inducted with 0.1 mg/kg midazolam, 3-6 μg/kg fentanyl, 2-4 mg/kg propofol, 0.3-0.6 mg/kg cis-atracurium, and maintained with propofol 1-4 mg/(kg·h) combined with 0.025-2.000 μg/(kg·min) fentanyl. We recorded the mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2) and airway peak pressure, and end-tidal carbon dioxide before anesthesia induction (T0), at endotracheal intubation (T1), during artificial lung-collapse when surgery initiated (T2), 5 minutes after surgery initiation (T3), 15 minutes after surgery initiation (T4), during artificial lung-collapse at the end of surgery (T5) and during extubation (T6). ResultsWhen compared with T0, T2 got a higher MAP, T3 and T4 had a slower HR (P<0.05), but all were within a normal range. All the patients showed little change in airway peak pressure and end-tidal carbon dioxide during the surgery with no statistically significant difference (P>0.05). ConclusionProper anesthetic procedure for left thoracic sympathectomy under thoracoscope for long QT syndrome patients can reduce the incidence of perioperative malignant arrhythmia.
Objective To summary the effects and prospects of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension. Methods Literatures which about the relationship between renal sympathetic nerves and hypertension， and the technical prospect and inadequacy of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension， were analyzed and reviewed. Results Hypertension， which as a seriously public health problem， was the focus of clinical treatment currently. Renal sympathetic nerve was certified playing an important role in regulation of blood pressure， and percutaneous radiofrequency catheter-based renal sympathetic denervation had potential superiority in the treatment of resistant hypertension. Conclusion Percutaneous radiofrequency catheter-based renal sympathetic denervation is an effective method for resistant hypertension.