Transaksilarna torakoskopska simpatektomija jednom incizijom
Sažetak
Uvod/Cilj. Uzroci primarne hiperhidroze nisu poznati. Ovaj poremećaj javlja se u ranom detinjstvu, a pogoršava se u pubertetu i zrelom dobu. Zastupljen je podjednako kod oba pola. Simptomi se pojačavaju sa porastom temperature, kao i zbog emocionalne napetosti koja deluje na simpatički nervni sistem. Cilj rada bio je prikaz video-assisted thoracoscopic surgery (VATS) simpatektomije kao metode trajnog lečenja problema prekomernog znojenja. Metoda jednom incizijom pruža minimalne estetske defekte, a maksimalan efekat operacije. Metode. Svi bolesnici koji su podvrgnuti torakoskopskoj simpatektomiji od T2–T5 simpatičkog gangliona primenom jedne male incizije u trećem međurebarnom prostoru, u nivou prednje aksilarne linije, analizirani su u vremenskom intervalu od septembra 2009. do novembra 2010. prema postoperativnom morbiditetu i ishodu operacije (klinička evaluacija i vizuelna analogna skala) radi procene efekta operacije izvedene na ovaj način. Rezultati. Analizirani su podaci 47 bolesnika (18 muškaraca, 29 žena), starih od 18 do 48 godina (prosečno 29 godina) kod kojih su urađene 94 bilateralne VATS simpatektomije. Indikacije za simpatektomiju uključivale su znojenje lica (6,38%), znojenje dlanova (34,04%), znojenje pazušnih jama (14,89%) i/ili dlanova i pazušnih jama (44,68%). Najveći procenat (98,6% ) bolesnika napustio je bolnicu sledećeg dana, postopeativni 30-dnevni mortalitet bio je 0 i nije bilo potrebe za konverzijom u otvorenu proceduru. Od komplikacija zabeležena je pojava parcijalnog pneumotoraksa kod dva bolesnika koji su lečeni eksuflacijom i torakalnom drenažom i pojava unilateralnog tranzitornog Hornerovog sindroma kod jednog bolesnika. Tromesečno i jednogodišnje praćenje nakon operacije ukazalo je na odlične funkcionalne i kozmetske efekte operacije bez rezidualnog bola. Kompletno povlačenje simptoma hiperhidroze zabeleženo je kod 44 (93,62%) bolesnika. Ponavljanje simptoma nakon početne regresije zabeleženo je kod tri (6,38%) bolesnika 12 meseci nakon operacije, dok je kod bolesnika koji su operisani zbog hiperhidroze lica značajno povećano znojenje stopala. Poboljšanje kvaliteta života primećeno je kod 45 (95,6%) bolesnika. Zaključak. Transaksilarna torakoskopska simpatektomija jednom incizijom daje odlične kozmetske i funkcionalne rezultate kod bolesnika sa primarnom fokalnom hiperhidrozom.
Reference
Moisiuc FV, Colt HG. Thoracoscopy: origins revisited. Respira-tion 2007; 74(3): 344−55.
Alexander W. Treatment of epilepsy. Edinburgh: Y.D. Pent-land; 1889.
Meachen GN. Profuse sweating. Practitioner 1911; 87: 589−92.
Kuntz A. Distribution of the sympathetic rami to the brachial plexus.Its relation to sympathectomy affecting the upper ex-tremity. Arch Surg 1927; 15: 871−7.
Reisfeld R, Berliner KI. Evidence-based review of the nonsurgical management of hyperhidrosis. Thorac Surg Clin 2008; 18(2): 157−66.
Solish N, Bertucci V, Dansereau A, Hong HC, Lynde C, Lupin M, et al. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recom-mendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg 2007; 33(8): 908−23.
Chandler KE. Video thoracoscopic dorsal sympathectomy : a new approach. Surg Laparosc Endosc 1993; 3(2): 112−4.
Samuelsson H, Claes G, Drott C. Endoscopic electrocautery of the upper thoracic sympathetic chain: a safe and simple tech-nique for tretment of sympathetically maintained pain. Eur J Surg Suppl 1994; (572): 55−7.
Lee LS, Ng SM, Lin CC. Single-lumen endotracheal intubated anaesthesia for thoracoscopic sympathectomy--experience of 719 cases. Eur J Surg Suppl 1994; (572): 27−31.
Rex LO, Drott C, Claes G, Göthberg G, Dalman P. The Borås ex-perience of endoscopic thoracic sympathicotomy for palmar, axillary, facial hyperhidrosis and facial blushing. Eur J Surg Suppl 1998; (580): 23−6.
Wittmoser R. Treatment of sweating and blushing by endo-scopic surgery. Acta Neurochir (Wien) 1985; 74(3−4): 153−4.
Rex LO, Drott C, Claes G, Göthberg G, Dalman P. The Borås ex-perience of endoscopic thoracic sympathicotomy for palmar, axillary, facial hyperhidrosis and facial blushing. Eur J Surg Suppl 1998; (580): 23−6.
Drott C, Claes G, Olsson-Rex L, Dalman P, Fahlén T, Göthberg G. Successful treatment of facial blushing by endoscopic transthoracic sympathicotomy. Br J Dermatol 1998; 138(4): 639−43.
Lin CC, Telaranta T. Lin-Telaranta classification: the impor-tance of different procedures for different indications in sym-pathetic surgery. Ann Chir Gynaecol 2001; 90(3): 161−6.
Reisfeld R, Nguyen R, Pnini A. Endoscopic thoracic sympathec-tomy for hyperhidrosis: experience with both cauterization and clamping methods. Surg Laparosc Endosc Percutan Tech 2002; 12(4): 255−67.
Krasna MJ, Jiao X, Sonett J, Gamliel Z, King K. Thoracoscopic sympathectomy. Surg Laparosc Endosc Percutan Tech 2000; 10(5): 314−8.
Lardinois D, Ris HB. Minimally invasive video-endoscopic sympathectomy by use of a transaxillary single port approach. Eur J Cardiothorac Surg 2002; 21(1): 67−70.
Yilmaz EN, Dur AH, Cuesta MA, Rauwerda JA. Endoscopic versus transaxillary thoracic sympathectomy for primary axil-lary and palmar hyperhidrosis and/or facial blushing: 5-year-experience. Eur J Cardiothorac Surg. 1996; 10(3): 168−72.
Neumayer C, Zacherl J, Holak G, Jakesz R, Bischof G. Experience with limited endoscopic thoracic sympathetic block for hyperhidrosis and facial blushing. Clin Auton Res 2003; 13 Suppl 1: I52−7.
Rajesh YS, Pratap CP, Woodyer AB. Thoracoscopic sympathec-tomy for palmar hyperhidrosis and Raynaud's phenomenon of the upper limb and excessive facial blushing: a five year experience. Postgrad Med J 2002; 78(925): 682−4.
Licht PB, Pilegaard HK, Ladegaard L. Sympathicotomy for iso-lated facial blushing: a randomized clinical trial. Ann Thorac Surg 2012; 94(2): 401−5.
Malmivaara A, Kuukasjärvi P, Autti-Ramo I, Kovanen N, Mäkelä M. Effectiveness and safety of endoscopic thoracic sympathec-tomy for excessive sweating and facial blushing: a systematic review. Int J Technol Assess Health Care 2007; 23(1): 54−62.
Khan AZ, Morgan SC, Currie IC, Lewis P, Lewis DR. Current practice of transthoracic endoscopic sympathectomy in the south west of England: an e-mail survey. Eur J Vasc Endovasc Surg 2001; 22(4): 373−5.
Lardinois D, Ris HB. Minimally invasive video-endoscopic sympathectomy by use of a transaxillary single port approach. Eur J Cardiothorac Surg 2002; 21(1): 67−70.
Herbst F, Plas EG, Függer R, Fritsch A. Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. A critical analysis and long-term results of 480 operations. Ann Surg 1994; 220(1): 86−90.
Wong CW. Transthoracic video endoscopic electrocautery of sympathetic ganglia for hyperhidrosis palmaris: special refer-ence to localization of the first and second ribs. Surg Neurol 1997; 47(3): 224−9; discussion 229−30.
Bonjer HJ, Hamming JF, du Bois NAJJ, van Urk H. Advantages of limited thoracoscopic sympathectomy. Surg Endosc 1996; 10(7): 721−3.
Raposio E, Filippi F, Nordström RE, Santi P. Endoscopic transthoracic dorsal sympathectomy for the treatment of up-per extremity hyperhidrosis: a new minimally invasive ap-proach. Plast Reconstr Surg 1998; 102(5): 1629−32.
Licht PB, Clausen A, Ladegaard L. Resympathicotomy. Ann Thorac Surg 2010; 89(4): 1087−90.
