Cosmetic Thoracic Sympathectomy for Palmar Hyperhidrosis using 2mm Thoracoscopic Instruments

다한증 환자에서 2 mm 흉강경 기구를 이용한 미용적 교감신경절제술

  • 성숙환 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 최용수 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 조광리 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 김영태 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 김주현 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실)
  • Published : 1998.05.01

Abstract

Thoracoscopic thoracic sympathectomy for primary palmar hyperhidrosis has been known to be effective and to have cosmetic merits compared to conventional open sympathectomy. In spite of its cosmetic advantages over thoracotomy, VATS using 5 mm or 10 mm instruments still has the problem of operative wound as well as pain on trocar sites. Recently, 2 mm thoracoscopic instruments have been used. The purpose of this study was to examine the results of thoracoscopic sympathectomy for palmar hyperhidrosis with 2 mm thoracoscopic instruments. From January 1997 to April 1997, 46 patients underwent bilateral thoracoscopic sympathectomy with 2mm instruments at Seoul National University Hospital. T-2 ganglion was carefully dissected and resected out in all patients. In one patient, the lower third of T-1 ganglion was inadvertently resected together with T-2 ganglion due to poor anatomical localization. In 4 patients who also complained of excessive axillary sweating, T-3 ganglion was resected as well. The instruments were removed without leaving any chest drain after reexpansion of the lung. Trocar sites were approximated with sterile tapes. All patients were relieved of excessive sweating in their upper extremities immediately after the operation. Nine patients(19.6%) showed incomplete reexpansion of the lung, and two of them required needle aspiration. Complications related to the surgical procedures, such as Horner's syndrome, hemothorax, and brachial plexus injury, were not detected in any cases. Most patientsdid not complaine of pain. All patients were discharged from the hospital on the day of operation. Despite a narrow operative viewfield, thoracic sympathectomy with 2 mm thoracoscopic instruments can be performed without increasing any severe complications. We recommend 2 mm instruments for thoracoscopic sympathectomy because they make as the more cosmetic, less painful, and equally effective compared to thoracoscopic sympathectomy using 5 mm or greater instruments.

일차성 다한증에 대한 흉강경을 이용한 흉부교감신경절제술은 효과적이면서도 기존의 방법에 비해 미용상의 장점이 있다고 알려져 있지만, 5 mm 또는 10 mm 기구를 이용한 흉강경 교감신경절제술은 트로카 부위의 통증과 상처의 문제를 여전히 갖고 있었다. 최근에 2 mm 흉강경 기구가 이용되기 시작하였는바, 서울대병원 흉부외과에서는 1997년 1월부터 4월까지 연속적으로 46명의 수장부 다한증 환자에서 2 mm 기구를 이용하여 양측성 교감신경절제술을 시행하였다. T2 신경절을 절제하였고 해부학적 위치가 불분명한 환자에서 T1 신경절의 하부 3분의 1을 함께 절제하였으며 액와부 발한도 호소한 4명의 환자들에서는 T3 신경절도 함께 절제하였다. 폐의 재팽창후 흉관삽입없이 트로카를 제거하였고 트로카 부위는 봉합없이 sterile tape 만 붙였다. 수술직후 전례에서 수장부 발한이 소실되었다. 수술수기에 관련된 합병증인 호너증후군, 혈흉, 상완신경총손상 등은 없었으며 아홉명(19.6%)에서 소량의 기흉이 있었으며 이 중 두 명에서는 needle aspiration이 필요하였다. 대부분의 환자에서 진통제가 필요없었으며 모든 환자가 수술당일에 퇴원하였다. 2 mm 흉강경 기구를 이용하여 심각한 합병증없이 다한증의 교감신경절제술을 안전하게 시술 가능하였으며, 미용상의 만족과 술 후 통증 감소의 결과를 얻었기에 2 mm 흉강경 기구가 기존의 5 mm나 10 mm 흉강경과 기구들에 비해 우월하다.

Keywords

References

  1. 대흉외지 v.28 비디오 흉강경을 이용한 다한증의 교감신경 절제술 성숙환;임청;김주현
  2. 대흉외지 v.26 no.2 비디오 흉강경을 이용한 흉부수술 김해균;이두연;윤용한;배기한
  3. Br J Surg v.78 Surgical management of pirmary hyperhidrosis Moran KT;Brady MP
  4. Arch Surg v.118 Surgical treatment of primary hyperhidrosis : a report of 42 cases Bogokowsky H;Slutzki S;Bacalu L;Abramsohn R;Negri M
  5. J Vasc Surg v.24 Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis : Improved intermediate-term results Kopelman D;Hashmonai M;Ehrenreich M;Bahous H;Assalia A
  6. Mayo Clin Proc v.61 Treatment of primary hyperhidrosis White JW
  7. Cutis v.26 Treatment of hyperhidrosis by tap iontophoresis Levit F
  8. JAMA v.186 Simple surgical approach to the management of axillary hyperhidrosis Hurley H;Shelley W
  9. Ann Plast Surg v.21 Treatment of bilateral axillary hyperhidrosis by suction-assisted lipolysis technique Tofield J
  10. Rev Med Suisse Rorriande v.30 Resection partielle de trone sympathetique surgical droit pour hyperhidrose unilaterale Kotzareff A
  11. J Neurosurg v.30 Hyperhidrosis Cloward B
  12. Neurosurgery v.15 Percutaneous radiofrequency upper thoracic sympathectomy: a new technique Wilkinssion HA
  13. Neurosurgery v.22 New stereotactic technique for percutaneous thermocoagulation of upper thoracic ganglionectomy in cases of palmar hyperhidorsis Chuang KS;Liou NH;Lin JC
  14. Lanect v.1 Sympathectomy by the axillary approach Atkins HJB
  15. Arch Surg v.92 Anterior transthoracic upper dorsal sympathectomy: current results Palumbo LT;Lulu DJ
  16. Dis Chest v.20 The endoscopic approach to the vegatative nervous system and its therapeutic possibilities Kux E
  17. Arch Surg v.15 Distribution of the sympathetic rami to the brachial plexus: its relation to sympathectomy affecting the upper extremity Kuntz A
  18. Vascular Surgery Sympathectomy for the upper extremities: anatomy, indications and techiques Roos DB;Rutherford R.
  19. Ann Surg v.186 Palmar hyperhidrosis and its surgical treatment Ador R;Kurchin A;Zoveig A(et al)
  20. J Neurosurg v.85 Orientation landmarks of endoscopic transaxillary T-2 sympathectomy for palmar hyperhidrosis Chiou TM;Liao KK