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Therapie der palmaren und axillären Hyperhidrose

Thorakoskopische Resektion des Truncus sympathicus

Treatment of palmar and axillary hyperhidrosis

Thoracoscopic resection of the sympathetic chain

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Zusammenfassung

Hintergrund

Die thorakale Sympathektomie ist eine etablierte Behandlungsoption bei Patienten mit primärer Hyperhidrose. Ungeklärte Fragen betreffen die optimale Technik der Sympathektomie und ob Patienten mit einer palmaren und axillären Hyperhidrose gleichermaßen von dem Eingriff profitieren.

Patienten und Methoden

Es erfolgte eine retrospektive Analyse prospektiv gesammelter Daten von 204 konsekutiven Patienten, bei welchen 402 thorakale Sympathektomien wegen palmar-plantarer (123), palmar-axillärer (34), isoliert axillärer (35) und kraniofazialer (12) Hyperhidrose durchgeführt wurden. Standardeingriff war die zweizeitige thorakoskopische Resektion des sympathischen Grenzstranges von T2 bis T4/T5.

Ergebnisse

Alle Eingriffe wurden thorakoskopisch durchgeführt, schwere perioperative Komplikationen traten nicht auf. Die postoperative Morbidität betrug 2,5% (10/402) und inkludierte 2 inkomplette Horner-Syndrome (0,5%). 143 Patienten wurden im Mittel 21 Monate (Spanne: 6–86) postoperativ nachuntersucht. Die palmare Hyperhidrose war in allen Fällen und die axilläre Hyperhidrose in 98,5% eliminiert, in 3 Axillen (1,5%) trat ein Rezidiv auf. Bei 60% der Patienten traten passagere, meist leichte Postsympathektomieneuralgien auf. Ein starkes kompensatorisches Schwitzen trat bei 17% der Patienten mit palmar-plantarer und palmar-axillärer und bei 53% der Patienten mit isolierter axillärer Hyperhidrose auf (p=0,001). Patienten mit palmar-plantarer und palmar-axillärer Hyperhidrose waren in 92% mit dem postoperativen Ergebnis sehr zufrieden, 90% gaben eine gesteigerte Lebensqualität an und 93% würden den Eingriff wieder durchführen lassen. Die entsprechenden Werte betrugen bei Patienten mit isolierter axillärer Hyperhidrose 47%, 44% und 66% (p<0,001).

Schlussfolgerung

Die thorakoskopische Resektion des sympathischen Grenzstranges von T2 bis T4/T5 ist ein sicheres und komplikationsarmes Verfahren und führt in nahezu 100% zur Elimination einer palmaren und axillären Hyperhidrose. Im Gegensatz zu den ausgezeichneten Ergebnissen bei Patienten mit palmar-plantarer und palmar-axillärer Hyperhidrose, weisen Patienten mit isolierter axillärer Hyperhidrose signifikant schlechtere Resultate bez. des kompensatorischen Schwitzens, der Lebensqualität und Zufriedenheit mit dem postoperativen Resultat auf.

Abstract

Background

Thoracic sympathectomy is a valuable treatment option for patients with primary hyperhidrosis. However, controversies exist about the optimal technique of sympathectomy and the association between localisation of the focal hyperhidrosis and postoperative results.

Patients and methods

Retrospective analysis was performed on prospectively collected data of 402 thoracic sympathectomies performed in 204 consecutive patients with palmar-plantar (n=123), palmar-axillary (34), isolated axillary (35), and craniofacial (12) hyperhidrosis. The standard procedure was video-assisted thoracoscopic resection of the sympathetic chain from T2 to T4/5.

Results

All procedures were performed thoracoscopically without serious perioperative complications. Postoperative morbidity was 2.5% (10/402) including two cases of incomplete Horner’s syndrome (0.5%). One hundred forty-three patients were followed for a mean of 21 months (6–86). Palmar hyperhidrosis was eliminated in 100% of cases and axillary hyperhidrosis in 98.5%. There were three axillary recurrences (1.5%). Of all patients, 60% suffered from transient postsympathectomy neuralgia which was mild in the majority of cases. Strong compensatory sweating occurred in 17% of patients with palmar-plantar and palmar-axillary hyperhidrosis and in 53% of patients with isolated axillary hyperhidrosis (P<0.001). In the palmar-plantar and palmar-axillary groups, 92% were very satisfied with the postoperative results, 90% reported increased quality of life, and 93% would repeat the operation. The corresponding numbers in patients with isolated axillary hyperhidrosis were 47%, 44%, and 66%, respectively (P<0.001).

Conclusion

Video-assisted thoracoscopic resection of the sympathetic chain from T2 to T4-5 is safe and effective and leads in almost 100% of cases to the elimination of palmar and axillary hyperhidrosis. In contrast to the excellent results in patients with palmar-plantar and palmar-axillary hyperhidrosis, outcome in patients with isolated axillary hyperhidrosis was impaired by a high rate of disturbing compensatory sweating.

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Danksagung

Für die statistische Aufarbeitung der Daten gilt unser Dank Herrn Univ. Prof. Mag. Dr. Werner Pölz, Abteilung für angewandte Systemforschung und Statistik, Johannes-Kepler-Universität Linz.

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  1. Abteilung für Chirurgie, Landeskrankenhaus Gmunden, eine Gesundheitseinrichtung der Gespag, Miller-von-Aichholz-Straße 49, 4810, Gmunden, Österreich

    R. Rieger, S. Pedevilla & S. Pöchlauer

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Correspondence to R. Rieger.

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Rieger, R., Pedevilla, S. & Pöchlauer, S. Therapie der palmaren und axillären Hyperhidrose. Chirurg 79, 1151–1161 (2008). https://doi.org/10.1007/s00104-008-1560-4

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