Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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The Effect of Thoracoscopic Sympathicotomy at the 4th Rib (R4) for Treating Palmar Hyperhidrosis

수부 다한증에서 제4번 늑골 위 교감신경절단술(R4)의 효과

  • Noh, Dong-Sub (Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, College of Medicine, Keimyung University) ;
  • Park, Chang-Kwon (Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, College of Medicine, Keimyung University) ;
  • Kum, Dong-Yoon (Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, College of Medicine, Keimyung University) ;
  • Kim, Jae-Bum (Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, College of Medicine, Keimyung University)
  • 노동섭 (계명대학교 의과대학 동산의료원 흉부외과학교실) ;
  • 박창권 (계명대학교 의과대학 동산의료원 흉부외과학교실) ;
  • 금동윤 (계명대학교 의과대학 동산의료원 흉부외과학교실) ;
  • 김재범 (계명대학교 의과대학 동산의료원 흉부외과학교실)
  • Published : 2008.06.05
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Abstract

Background: Thoracoscpic sympathicotomy is an effective treatment for essential hyperhidrosis. Patients are generally satisfied with the surgery at the early post operative period, but they suffer from recurrence and compensatory sweating at the late post operative period. There are many sympathicotomy methods for minimizing recurrence and the compensatory sweating. We compared the outcome from between the R3 and R4 sympathicotomy methods for the symptoms, atisfaction, recurrence and compensatory sweating. Material and Method: From January 1999 to July 2007, 39 cases of thoracoscopic sympathicotomy at the 3rd rib (R3) and 72 cases of thoracoscopic sympathicotomy at the 4th rib (R4) for treating palmar hyperhidrosis were compared for the early and late satisfaction, the compensatory sweating and recurrence. Result: There is no difference of gender and age for the 2 groups. Early satisfaction was reported by 94.9% of the R3 patients and by 98.7% of the R4 patients. 84.6% of the R3 patients reported late satisfaction and 87.5% of the R4 patients reported late satisfaction. There were no significant differences between the groups for the early and late satisfaction. But there was a difference between the groups for compensatory sweating (23.1% in the R3 group and 9.7% in the R4 group (p=0.020)). The reoperation rate due to recurrence was 5.1% in the R3 group and 4.2% in the R4 group. There was no significant difference between the groups for recurrence. Conclusion: R4 sympathicotomy has excellent therapeutic results for compensatory sweating as compared to R3 sympathicotomy for treating palmar hyperhidrosis.

배경: 다한증 환자에서 흉부교감신경절단술은 효과적인 치료방법으로, 수술직후에는 만족도가 높으나 시간이 지남에 따라 재발 및 보상성 발한으로 인해 만족도가 떨어지는 경향이 있다. 재발 및 보상성 발한을 최소화하기 위해 신경절제를 위한 다양한 방법이 제시되고 있다. 이에 흉부교감신경의 절단범위에 따른 증상 및 만족도, 재발, 보상성 발한을 비교 평가하였다. 대상 및 방법: 1999년 1월부터 2007년 7월까지 수부 다한증으로 흉부 교감신경절단술을 시행한 180명의 환자 중 술 후 추적이 가능했던 111명을 대상으로 하였다 제3번 늑골 상연에서 교감신경절을 절단한 39예(R3)와 제4번 늑골상연에서 교감신경절을 절단한 72예(R4)로 나누어서 술 후 초기 및 중기 만족도, 보상성 발한, 재발의 정도를 비교하였다. 결과: 두 군간의 연령에 있어서는 차이가 있었으나 성별에 있어서는 차이가 없었다. 초기의 만족도(R3, R4)는 각각 94.9%, 98.7%로 차이가 없었고, 중기 만족도 또한 84.6%, 87.5%로 차이가 없었다. 일상 생활에 불편함을 초래하는 중증도 이상의 보상성 발한은 R3에서 23.1%, R4에서 9.7%로 유의한 차이를 보였다(p=0.020). 재발되어 재수슬한 경우는 각각 5.1%, 4.2%로 유의한 차이를 보이지는 않았다. 결론: 수부다한증의 치료에 있어 교감신경절단술 시 R4가 R3에 비해 초기 및 중기 만족도 및 재발에 있어서는 차이가 없으나, 술 후 보상성 발한이 보다 적은 것으로 보인다.

Keywords

References

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