Berker ÖZKAN, İsa DÖNGEL, Serhan TANJU, Alper TOKER

Palmar ve aksiller hiperhidroz tedavisinde iki taraflı torakoskopik sempatektominin uzun dönem sonuçları: Sekiz yıllık deneyim

Amaç: Bu çalışmada medikal tedaviye yanıt vermeyen vekişilerin sosyal yaşamını ciddi düzeyde etkileyen palmar ve aksiller hiperhidroz yakınması nedeni ile endoskopik torakal sempatektomi (ETS) uygulanan hastaların uzun dönem sonuçları değerlendirildi.Çalışma planı: Haziran 2004 - Haziran 2011 tarihleri arasında kliniğimizde 35 hastaya (18 erkek, 17 kadın; ort. yaş 24±5.7 yıl; dağılım 17-40 yıl) aynı seansta iki taraflı uygu- lanan 70 ETS ameliyatı retrospektif olarak incelendi. T2-3,T2-4 ve T2-5 düzeyinde sempatik gangliyonların rezeksiyonu ve Kuntz sinirinin koterizasyonu için endoskopik olarak iki (%97.1) veya üç (%2.9) torakoport kullanıldı. Hastalar uygulanan cerrahi teknik, ameliyat süresi, ameliyat sırası ve sonrası komplikasyonlar ve hasta memnuniyeti ve uzun dönemsonuçlar açısından incelendi. Ortalama takip süresi 37.9 ay(dağılım 8-81 ay) idi.Bulgular: Cerrahi mortalite gözlenmedi. Bir hastada (%2.9) ameliyat sonrası dönemde girişim gerektiren pnömotoraks gelişti. Uzun dönem takiplerde 25 hastada(%71.4) vücudun çeşitli yerlerinde kompansatuvar hiper-hidroz (%8 ciddi, %12 orta, %80 hafif) ve bir hastada(%2.9) kısmi nüks gelişti. Otuz üç hasta (%94.3) ETS’nin sonucundan memnun olduğunu, iki hasta (5.7%) ise kısmenmemnun olduğunu belirtti.Sonuç: Endoskopik torakal sempatektominin geç dönemdegelişen kompansatuvar terleme riskine rağmen, ameliyat öncesi dönemde iyi bilgilendirilerek dikkatle seçilmiş palmar ve aksiller hiperhidrozlu hastaların tedavisinde, düşük morbidite, mortalite ve uzun dönem takiplerde yüksek memnuniyet oranları iletercih edilebilecek bir seçenek olduğu kanaatindeyiz.

Long-term results of bilateral endoscopic thoracic sympathectomy for palmar and axillary hyperhidrosis: an eight-year experience

Background: This study aims to evaluate the long-term results of endoscopic thoracic sympathectomy (ETS) in patients who are refractory to medical treatment and are operated due to palmar and axillary hyperhidrosis which severely affect their social life. Methods: Between June 2004 and June 2011, we retrospectively analyzed 70 two-sided simultaneous ETS operations which were performed on 35 patients (18 males, 17 females; mean age 24±5.7 years; range 17-40 years). Two (97.1%) or three (2.9%) thoracoports were used endoscopically for the resection of sympathetic ganglions on level T2-3, T2-4 and T2-5 and for cauterization of the Kuntz’s nerve. Patients wereanalyzed in terms of surgical technique applied, duration of surgery, intra- and postoperative complications, long-term results and patient satisfaction. The mean follow-up was 37.9 months (range, 8-81 months). Results: No surgical mortality was observed. Pneumothorax requiring a postoperative intervention developed in one patient (2.9%). Long-term follow-up revealed compensatory hyperhidrosis (8% severe, 12% moderate, 80% mild) involving various parts of the body in 25 patients (71.4%) and partial recurrence in one patient (2.9%). Thirty-three patients (94.3%) reported that they were satisfied with the results of ETS, while two (5.7%) reported partial satisfaction. Conclusion: Despite the risk for compensatory hyperhidrosis in the long-term, we believe that ETS is an effective treatment method for the patients with palmar and axillary hyperhidrosis who are well-informed and carefully selected preoperatively with lower morbidity, mortality and higher satisfaction rates in the long-term follow-up period.

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