Comparison of the efficacy of bilateral thoracic sympathectomy at different segments of T3 and T4 under tho-racoscopy for treatment of primary palmar hyperhidrosis

WANG Tengteng; ZHI Xiuyi; LIU Baodong; ZHANG Peilong

doi:10.3969/j.issn.1674-3806.2024.06.13

Abstract：Objective To compare the efficacy of bilateral thoracic sympathectomy at different segments of T3 and T4 under thoracoscopy for treatment of primary palmar hyperhidrosis(PPH).Methods The clinical data of 125 patients with PPH who underwent thoracic sympathectomy under thoracoscopy in the Department of Thoracic Surgery of Xuanwu Hospital Capital Medical University from January 2017 to March 2023 were retrospectively collected.The patients were divided into T3 group(60 cases)and T4 group(65 cases)according to thoracic sympathectomy at different segments.The T3 group underwent bilateral thoracic sympathectomy at segment of T3 under thoracoscopy,and the T4 group underwent bilateral thoracic sympathectomy at segment of T4 under thoracoscopy.The clinical data,the recurrence rate of PPH and the occurrence of compensatory hyperhidrosis(CH)at different time points after the operation,and the patients'satis-faction with the operation at 12 months after the operation were compared between the two groups.Results There were no statistically significant differences in age,gender,family history,duration of symptoms,PPH grade,duration of surgery,postoperative complications and length of hospital stay between the two groups(P＞0.05),and the surgical effectiveness rate was 100％in both groups.At 1 month,6 months and 12 months after surgery,there were no significant differences in the recurrence rates of PPH between the two groups(P＞0.05).At 1 month after surgery,there were no significant differences in the incidence of CH and the severity of CH between the two groups(P＞0.05).At 6 months and 12 months after surgery,the incidence of CH in the T3 group was significantly higher than that in the T4 group(P＜0.05),and there was significant difference in the severity of CH between the two groups(P＜0.05).At 12 months after surgery,there was no significant difference in the patients'satisfaction with the operation between the two groups(P＞0.05).Conclusion Both bilateral thoracic sympathectomy at segment of T3 under thoracoscopy and bilateral thoracic sympathectomy at segment of T4 under thoracoscopy have good efficacy in the treatment of PPH.Compared with bilateral thoracic sympathectomy at segment of T4,bilateral thoracic sympathectomy at segment of T3 results in higher incidence rates of CH at 6 months and 12 months after surgery.