[The choice of thoracoscopic sympathectomy in the treatment of palmar hyperhidrosis among different procedures].

Objective: Retrospective analyze the long-term efficacy and compensatory sweating of thoracoscopic sympathectomy in the treatment of palmar hyperhidrosis by different operative methods in order to search after a better operative method.

Methods: Retrospective study of 643 cases (498 cases available) palmar hyperhidrosis who accepted video-assisted thoracoscopic bilateral sympathectomy during from 1995 to Aug 2008. The patients were divided into four groups by different operative methods. (1) Group A(n = 82): Thoracoscopic T2-4 sympathectomy was performed. (2) Group B (n = 135): Thoracoscopic T2 sympathectomy was performed. (3) Group C (n = 41): Thoracoscopic T2 sympathetic nerve clipped. (4) Group D (n = 240): Thoracoscopic T3-4 level sympathectomy plus bypass fiber (Kuntz fiber) resection on same level was performed.

Results: All procedures were successfully performed under thoracoscope without severe morbidity and mortality. The curative rate of palmar hyperhidrosis was 100.00%. The incidence of compensatory sweating were 54.9% (group A), 48.1% (group B), 48.8% (group C) and 28.8% (group D) respectively with significantly decrease in group D contrast to other three groups. The incidence of high-grade compensatory sweating which have important influences on daily life were 9.8% (group A), 10.4% (group B), 9.8% (group C) and 2.9% (group D) respectively with significantly decrease in group D. Other pairings have nonsignificance. The relapse rate were 1.2% (group A), 2.2% (group B), 7.3% (group C) and 0.8% (group D). Only when group D contrasted to group C has significantly decrease in the relapse rate (χ(2) = 8.423, P = 0.004). Other pairings have nonsignificance.

Conclusion: The procedure of T3-4 sympathectomy plus bypass fiber resection is reasonable operative method to cure hyperhidrosis with the better curative effect and lowest incidence of compensatory hyperhidrosis.