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[1]韦韦,刘宏,许罡,等.体系部队官兵原发性手汗症的非气管插管微创手术治疗[J].医学研究与战创伤救治(原医学研究生学报),2018,20(02):142-147.[doi:10.3969/j.issn.1672-271X.2018.02.008]
　WEI Wei,LIU Hong,XU Gang,et al.Treatment ofpalmar hyperhidrosis by non-intubated anesthesia and minimally invasive surgery of our troops[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(02):142-147.[doi:10.3969/j.issn.1672-271X.2018.02.008]
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体系部队官兵原发性手汗症的非气管插管微创手术治疗()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第20卷
期数:
2018年02期
页码:
142-147
栏目:
出版日期:
2018-03-20

文章信息/Info

Title:
Treatment ofpalmar hyperhidrosis by non-intubated anesthesia and minimally invasive surgery of our troops
作者:
韦韦; 刘宏; 许罡; 韩开宝
作者单位：210002南京，南京中医药大学附属八一医院胸心外科（韦韦、刘宏、许罡、韩开宝）
Author(s):
WEI Wei; LIU Hong; XU Gang; HAN Kai-bao
（Department of Cardiothoracic Surgery, the 81th Hospital Affiliated Nanjing University of Chinese Medicine,Nanjing 210002, Jiangsu,China)
关键词:
原发性手汗症; 微创; 非气管插管; 膀胱镜; 电视胸腔镜; 军人
Keywords:
primary palmar hyperhidrosis;  minimally Invasive;  non-intubated anesthesia;  cystoscope;  video-assisted thoracic surgery;  military
分类号:
R758.74
DOI:
10.3969/j.issn.1672-271X.2018.02.008
文献标志码:
A
摘要:
目的 探讨非气管插管微创手术治疗体系部队军人原发性手汗症的有效性及安全性。方法 回顾性分析解放军第八一医院医院胸心外科2014年7月至2017年7月21例体系部队原发性手汗症患者临床资料,采用保留自主呼吸静脉全麻+肋间神经阻滞+胸膜表面麻醉技术膀胱镜下行双侧交感干切断术，体位取45°半卧位，双上肢外展90°，术中无需变换体位，男性乳晕下弧形切口、女性采用腋下第3肋间5mm切口，术后不留置胸管、切口宽胶布粘贴。结果 21例患者均顺利完成手术，无围术期死亡病例，1例发生左侧气胸，1例发生窦性心动过缓，1例术中发生低氧血症，无气管插管相关并发症，随访1~37个月，手术效果满意，1例发生轻度胸背部代偿性多汗，1例发生手足干燥，无复发病例。结论 采用留自主呼吸非插管静脉全麻+肋间神经阻滞+胸膜表面麻醉，同时采用膀胱镜取代传统胸腔镜切断双侧交感干治疗经过严格筛选的原发性手汗症患者安全、可行、有效，可在基层医院推广。
Abstract:
Objective To explore the validity and safety of video-assisted thoracoscopic sympathectomy by non-intubated anesthesia and spontaneous breathing combined intercostal nerve block and pleura surface anesthesia in treatment of primary palmar hyperhidrosis by cystoscope of our troops.Methods From July 2014 to July 2017, we used cystoscope to replace the traditional thoracoscope in bilateral thoracic sympathectomy via a 5 mm incision in the treatment of 21 military of palmar hyperhidrosis by non-intubated anesthesia and spontaneous breathing combined intercostal nerve block and pleura surface anesthesia. We selected semisupine position 45°, abduction of the upper limbs 90° without operation position changing, the areola incisions in male, and the third intercostal incisions at midaxillary line in female. The adhesive plaster paste the incisions without chest tube post operation.Results The operation was completed successfully in all 6 cases. No mortality or serious complications were observed during the perioperation. No one needed thoracotomy in the period of surgery. 1 case took place left minor pneumothorax, 1 case had sinus bradycardia and 1 case suffered from postoperative hypoxemia. There were no complications of tracheal intubation. From follow-up for 1-37 months, we found 1 case of thoracodorsal compensatory hyperhidrosis and 1 case of excessive dryness, no recurrence was found.Conclusion The use of video-assisted thoracoscopic sympathectomy by non-intubated anesthesia and spontaneous breathing combined intercostal nerve block and pleura surface anesthesia in treatment of primary palmar hyperhidrosis by cystoscope is safe, feasible, and effective. This surgical method can be used in grass root hospital which lack thoracoscope, but more high-quality, multiple-center and large-sample randomized controlled trials are required.

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备注/Memo

备注/Memo:
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更新日期/Last Update: 2018-03-20