中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2014年
10期
606-610
,共5页
胸腔镜下交感神经切断术%手汗症%Meta分析%代偿性出汗
胸腔鏡下交感神經切斷術%手汗癥%Meta分析%代償性齣汗
흉강경하교감신경절단술%수한증%Meta분석%대상성출한
Thoracoscopic sympathectomy%Palmar hyperhidrosis%Meta analysis%Compensatory hyperhidrosis
目的 系统评价胸腔镜下交感神经切断术(video-assisted thoracoscopic sympathectomy,VTS)在手汗症治疗中的作用,分析不同交感神经节段手术间疗效的差异.方法 通过PubMed数据库搜索过去10年VTS治疗手汗症相关研究,选取其中涉及不同节段手术效果对比的文献报道并提取相关数据,以术后代偿性出汗作为主要评价指标,运用RevMan 5.2软件系统分析不同节段手术间效果差异.结果 经过筛选,纳入11篇随机对照实验(randomized controlled trial,RCT),共1 413例患者,均行双侧VTS手术.单节段与多节段手术有效率间差异无统计学意义(97.7％对98.8％,P＜0.01),纳入文献中单节段组术后代偿性出汗发生率均低于/等于多节段组.Meta分析结果显示,单独对单节段手术进行对比,T2、T3组术后代偿性出汗发生率与其他节段手术差异无统计学意义[T2节段对其他节段,RR=1.11,95％ CI(0.99,1.24);T3节段对其他节段,RR =0.99,95％ CI(0.89,1.11)],T4节段术后代偿性出汗发生率明显低于其他节段手术[RR =0.67,95％ CI(0.57,0.79)];在单节段手术组内对比,低节段手术较高节段手术术后代偿性出汗发生率明显减低[RR =0.75,95％ CI(0.68,0.84)].结论 低节段限制性手术能明显降低术后代偿性出汗发生率,其中T4节段VTS具有最佳手术效果.
目的 繫統評價胸腔鏡下交感神經切斷術(video-assisted thoracoscopic sympathectomy,VTS)在手汗癥治療中的作用,分析不同交感神經節段手術間療效的差異.方法 通過PubMed數據庫搜索過去10年VTS治療手汗癥相關研究,選取其中涉及不同節段手術效果對比的文獻報道併提取相關數據,以術後代償性齣汗作為主要評價指標,運用RevMan 5.2軟件繫統分析不同節段手術間效果差異.結果 經過篩選,納入11篇隨機對照實驗(randomized controlled trial,RCT),共1 413例患者,均行雙側VTS手術.單節段與多節段手術有效率間差異無統計學意義(97.7％對98.8％,P＜0.01),納入文獻中單節段組術後代償性齣汗髮生率均低于/等于多節段組.Meta分析結果顯示,單獨對單節段手術進行對比,T2、T3組術後代償性齣汗髮生率與其他節段手術差異無統計學意義[T2節段對其他節段,RR=1.11,95％ CI(0.99,1.24);T3節段對其他節段,RR =0.99,95％ CI(0.89,1.11)],T4節段術後代償性齣汗髮生率明顯低于其他節段手術[RR =0.67,95％ CI(0.57,0.79)];在單節段手術組內對比,低節段手術較高節段手術術後代償性齣汗髮生率明顯減低[RR =0.75,95％ CI(0.68,0.84)].結論 低節段限製性手術能明顯降低術後代償性齣汗髮生率,其中T4節段VTS具有最佳手術效果.
목적 계통평개흉강경하교감신경절단술(video-assisted thoracoscopic sympathectomy,VTS)재수한증치료중적작용,분석불동교감신경절단수술간료효적차이.방법 통과PubMed수거고수색과거10년VTS치료수한증상관연구,선취기중섭급불동절단수술효과대비적문헌보도병제취상관수거,이술후대상성출한작위주요평개지표,운용RevMan 5.2연건계통분석불동절단수술간효과차이.결과 경과사선,납입11편수궤대조실험(randomized controlled trial,RCT),공1 413례환자,균행쌍측VTS수술.단절단여다절단수술유효솔간차이무통계학의의(97.7％대98.8％,P＜0.01),납입문헌중단절단조술후대상성출한발생솔균저우/등우다절단조.Meta분석결과현시,단독대단절단수술진행대비,T2、T3조술후대상성출한발생솔여기타절단수술차이무통계학의의[T2절단대기타절단,RR=1.11,95％ CI(0.99,1.24);T3절단대기타절단,RR =0.99,95％ CI(0.89,1.11)],T4절단술후대상성출한발생솔명현저우기타절단수술[RR =0.67,95％ CI(0.57,0.79)];재단절단수술조내대비,저절단수술교고절단수술술후대상성출한발생솔명현감저[RR =0.75,95％ CI(0.68,0.84)].결론 저절단한제성수술능명현강저술후대상성출한발생솔,기중T4절단VTS구유최가수술효과.
Objective To evaluate video-assisted thoracoscopic sympathectomy(VTS) for the treatment of palmar hyperhidrosis(PH),and to analyze curative efficacies for surgeries on different sympathetic segments.Methods Medline search was done on PubMed and data of randomized controlled trials(RCTs) about comparisons of surgeries on different segments over the past decade were collected.According to the inclusion criterion,relevant articles were screened.Then we extracted data,assessed trail quality,and performed Meta-analysis by using RevMan 5.2 with postoperative compensatory hyperhidrosis(CH) as the main evaluation index.Results A total of 11 RCTs involving 1 413 patients were included,among which all patients underwent bilateral VTS.Ef cacious rates were similar between multiple and single ganglia sympathectomy(97.7％ vs 98.8％,P ＜0.01).However,single-ganglia group showed a lower risk of CH compared to multiple-ganglia group.Meta-analysis suggested that,in the subgroups of the single-ganglia VTS,no significant difference was found between T2/T3 and other segments in the risk of CH [T2 segment vs other segments,RR =1.11,95 ％ CI(0.99,1.24) ; T3 segment vs other segments,RR =0.99,95％ CI(0.89,1.11)].The risk of CH was significantly lower in T4 sympathectomy than in other segments [RR =0.67,95％ CI(0.57,0.79)].By comparison of T2,T3 and T4 sympathectomy,we found that low segment had a lower risk of CH than high segment[RR =0.75,95％ CI(0.68,0.84)].Conclusion Single-ganglia and low segment sympathectomy can significantly reduce the incidence of CH,and T4 is supposed to be the best segment for the treatment of PH.
