안면 다한증에서 T2 Sympathetic Clipping과 T2 Ramicotomy의 비교 연구

Abstract

Compensatory sweating is the main cause of patient dissatisfaction after sympathetic surgery for craniofacial hyperhidrosis. Surgery that sympathetic nerve trunk preserved and extent of resection limited was introduced to decrease compensatory sweating. From Jan 2000 to July 2002, the vidio-assisted thoracoscopic T2 sympathetic clipping and rami comunicantes selective division were performed in 36 patients suffering from craniofacial hyperhidrosis. Twenty two patients underwent a T2 sympathetic nerve clipping (Group 1), and fourteen patients underwent division of the T2 ramicommunicates (Group 2). We retrospectively analysed the rate of satisfaction, dryness of face, the rate of compensatory sweating, grade of compensatory sweating. The dryness of face was that no statistical difference between group 1 and group 2 (p=0.387); group1: dry 22.7% (5/22), humid 77.3% (17/22) group 2: dry 14.3% (2/14), humid 78.5% (11/14), persist 7.2% (1/14). The rate of satisfaction was 77.3% in T2 clipping and 64.2% in T2 sympathicotomy with no significant in the statistic analysis (p=0.396). The rate of compensatory sweating on group 2 was lower than group 1 (p=0.042); 95.4% (21/22) in T1 sympathetic clipping and 71.4% in T2 ramicotomy. The rate of embarrassing and disabling compensatory sweating was 70.5% (embarassing 8 patients, disabling 9 patients) in T2 clipping and 42.9% (embarassing 8 patients, disabling 9 patients)in T2 ramicotomy with statistically significant difference (p=0.036). The sympathetic trunk preservation surgery for craniofacial hyperhidrosis (T2 ramicotomy) redueced the rate of compensatory sweating when compared to the blocking surgery of sypathetic trunk (T2 clipping).