目的评价喉罩或单腔气管内插管在胸腔镜下胸交感神经链切断术的应用效果。 方法选择80例行胸腔镜下胸交感神经链切断术的手汗症患者，采用计算机随机法将患者分为A、B两组，每组各40例。其中A组男20例、女20例，平均年龄24岁；B组男21例、女19例，平均年龄23岁。A组使用喉罩通气，B组使用单腔气管内导管，均应用小潮气量较快频率正压通气及间歇人工气胸。观察两组麻醉期间各时点心率（HR）、平均动脉压（MAP）、呼气末二氧化碳分压（PetCO2）、动脉血氧饱和度（SpO2）、心电图（ECG）的变化。同时记录喉罩/单腔导管置入时间、CO2充气时间、手术时间、术中术后不良反应和并发症。 结果两组患者手术顺利，无并发症。A组喉罩/插管置入时间和喉罩/单腔管呛咳、术后咽喉疼痛发生率低于B组，差异有统计学意义（P<0.05）。B组MAP、HR水平在T2（喉罩/单腔管置入后）和T7（苏醒后拨喉罩/单腔管时）明显高于T1（麻醉诱导完成），差异有统计学意义（P<0.05）；A组MAP、HR水平在T2和T7时亦明显低于B组，差异有统计学意义（P<0.05）。所有患者术中ECG、SpO2和PetCO2无明显变化。 结论喉罩或单腔气管内插管结合间歇的人工气胸都能满足胸交感神经切断术的操作需要，喉罩具有更稳定的血流动力学状态和更高的安全性。
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 investigate the safety of endoscopic thoracic sympathicotomy in the treatment of primary hyperhidrosis based on ambulatory surgery mode.MethodsRetrospective analysis was performed on the clinical data of 158 patients with primary hyperhidrosis who received endoscopic thoracic sympathicotomy in the Affiliated Hospital of Zunyi Medical University from January 2019 to March 2021. There were 68 (43.2%) males and 90 (56.8%) females with an average age of 14-33 (20.5±3.1) years. The basic information of the patients, operation time, intraoperative blood loss, postoperative pain score, hospitalization expenses and postoperative complications were observed and recorded.ResultsAll surgeries were successfully completed and the patients were discharged as planned. The operation time was 41.8±13.9 min, the intraoperative blood loss was 10.5±7.3 mL, the postoperative anesthesia recovery time was 15.0±5.9 min, and the pain score was 3.0±0.9 points. The total length of hospitalization was 1.6±1.0 days. The total postoperative expenses were 9 471.7±1 698.9 yuan. Pneumothorax occurred after the operation in 3 patients. Telephone follow-up on the 30th day after the operation showed no recurrence of sweaty hands, pneumothorax or rapid heart rate, and no serious complications or death related to the day operation within 30 days after the operation.ConclusionEndoscopic thoracic sympathicotomy based on ambulatory surgery mode is safe and effective in the treatment of primary hyperhidrosis.
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.
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 evaluate the quality of life (QOL) in patients with primary palmar hyperhidrosis (PPH) after endoscopic thoracic sympathicotomy (ETS) and analyze the influencing factors. MethodsA total of 243 patients (118 males and 125 females, with an average age of 21.99±6.31 years) with PPH who were successfully treated with ETS (only T3 level thoracic sympathicotomy) in our hospital from January 2017 to January 2018 were enrolled, and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) was used to assess the QOL scores before and after ETS. By establishing a linear regression model of gender, age, body mass index, compensatory hyperhidrosis (CH) and palm dryness, and the relationship between the changes of the QOL scores and various factors was studied. ResultsThe total QOL score after surgery was higher than that before surgery (63.01±4.58 vs. 48.11±1.95, P<0.05). Compared with the negative group of CH, the QOL score decreased by 4.662 in the postoperative CH patients. For every grade of CH severity increasing, the QOL score decreased by 3.449. Compared with the negative group, the QOL scores decreased by 1.804 and 2.400 respectively for every grade of CH severity increasing in the patients with postoperative chest and back CH. ConclusionETS can not only improve the symptoms of abnormal palmar hyperhidrosis, but also significantly improve the QOL. Severe chest and back CH is an important factor affecting the QOL of patients.
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.
睡眠过程中反复出现呼吸暂停造成的间歇低氧是阻塞性睡眠呼吸暂停低通气综合征( OSAHS) 的主要病理生理学特点, 它能够导致自主神经, 特别是交感神经兴奋性异常增高[1] , 后者可能是OSAHS合并心血管疾病包括高血压、充血性心力衰竭、心肌梗死以及心律失常的主要危险因素之一[2,3] 。现将慢性间歇低氧( chronic intermittent hypoxia,CIH) 所致交感神经异常兴奋的相关研究作一综述。
ObjectiveTo compare the short- and long-term effects of R4 versus R3+R4 endoscopic thoracic sympathicotomy (ETS) for acrohyperhidrosis. MethodsWe retrospectively analyzed the clinical data of patients with acrohyperhidrosis admitted to the Department of Thoracic Surgery of Gansu Provincial Hospital for surgical treatment from April 2014 to April 2021. The patients were divided into two groups according to the methods of ETS, including a R4 group and a R3+R4 group. Perioperative clinical data and postoperative follow-up data were collected to compare the short- and long-term outcomes of the two groups. ResultsA total of 155 eligible patients were included. There were 60 patients in the R4 group, including 23 males and 37 females, with a mean age of 22.55±2.74 years. There were 95 patients in the R3+R4 group, including 40 males and 55 females, with a mean age of 23.14±3.65 years. There were no statistical differences between the two groups in terms of baseline indicators such as gender, age and positive family history (P>0.05). Total operative time was 38.67±5.20 min in the R4 group and 40.05±5.18 min in the R3+R4 group; intraoperative bleeding was 7.25±3.25 mL in the R4 group and 7.95±3.90 mL in the R3+R4 group; postoperative hospital stay was 1.28±0.52 d in the R4 group and 1.38±0.57 d in the R3+R4 group, the differences between the two groups in the above indicators were not statistically significant (P>0.05). Postoperative hand hyperhidrosis symptoms were significantly relieved in both groups, and the complete remission rate was better in the R3+R4 group than that in the R4 group (98.0% vs. 93.3%), but the difference was not statistically significant (P=0.358). The R3+R4 group was superior to the R4 group in terms of the relief of plantar hyperhidrosis symptoms, patient satisfaction and quality of life index at 6 months postoperatively (P<0.05). There was no statistical difference in the overall incidence of compensatory hyperhidrosis at 12 months postoperatively between the two groups (P=0.867), but the incidence of compensatory hyperhidrosis was higher in the R3+R4 group than that in the R4 group (72.6% vs. 70.0%). ConclusionThe perioperative outcomes of R4 and R3+R4 ETS are similar, but R3+R4 ETS has a higher rate of symptomatic relief of acrohyperhidrosis, and patients have a better postoperative quality of life. R3+R4 ETS is a reliable option for the treatment of acrohyperhidrosis. However, patients need to be informed that this procedure may increase the risk of compensatory hyperhidrosis.