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加拿大醫生為錯誤手汗手術認錯懺悔。美國胸腔外科醫師協會:83%病人後...

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美國胸腔外科醫師協會:百分之83的病人表示後悔開刀

February 12, 2005 Volume 41 Issue 07

美國胸腔外科醫師協會:





STS: Sympathectomy's success variable

Compensatory sweating affects most patients who undergo cutting of sympathetic ganglia (交感神經切除手術 會產生代償性出汗影響大部份的病患)[/b]

By Heather Ennis

TAMPA, FLA. – A common procedure to bring relief to patients who suffer from excess sweating became the subject of heated debate here as two contradictory papers reported varying degrees of postoperative symptoms and arrived at conflicting conclusions on how and when the surgery should be performed.

Sympathectomy is often the last resort for patients who experience excessive sweating on their palms, face, scalp and underarms. The procedure involves interrupting the nerve signal that causes sweating in the affected area by selectively cutting, clipping or excising part of the sympathetic ganglia. Several methods are commonly performed, and each has drawn mixed results in the literature.

A study involving 121 patients reported here by surgeons from Dallas showed the success of the surgery after one year was dependent on the type of sympathectomy performed. Researchers follow a protocol that involves excising a small part of the T2 ganglia for facial sweating or blushing, the T3 ganglia for hand sweating and T4 ganglia for armpit sweating. In patients with mixed symptoms, multiple excisions were performed.(美國達拉斯外科醫師 調查121位 交感神經切除手術病患)[/b]

Palm sweating treatable

"The patients who were most satisfied were those whose sympathectomies were performed for isolated palmar sweating," said Dr. Todd Dewey of the Medical City Dallas Hospital. "Our most dissatisfied patients were those who had sympathectomy for isolated face sweating, face and axillary sweating, and face, palms and axillary sweating."



The most common postoperative symptom following sympathectomy is increased sweating on other parts of the body, most often the back, legs, groin and abdomen. This compensatory sweating can be mild or severe, and occurred in 82% of the Dallas patients.

(在達拉斯手術的病患大約有82%產生 溫和 或者嚴重的 代償性出汗)[/b]

Dissatisfied patients seemed to have something in common, said Dr. Dewey, who noted people who underwent surgery involving the T2 ganglia were more likely to experience disabling compensatory sweating after the procedure.(不滿意的病患 大都是第二節交感神經切除手術病患 在手術之後 產生幾乎是殘障 的代償性出汗)[/b]

"We would recommend limiting the level of resection to one level if possible or detailed patient counselling for all multi-level or T2 resections regarding the possibility of severe compensatory symptoms," he said.

Fully 83% of patients who underwent T2 sympathectomy reported severe compensatory sweating one year after surgery and the majority of those reported they regretted the decision to have the surgery.( 百分之83的病人作第二節交感神經切除手術 表示一年後 產生嚴重的代償性出汗 大部份的病患表示後悔開刀)[/b]

"Patients with T2 resections strongly report they would not have the surgery again except if T3 was part of the excision," said Dr. Dewey. "This is probably because palmar symptoms are more socially stigmatizing and that overrode their severe compensatory sweating."(第二節交感神經切除病患 強烈的反應 “寧願不作手術”因為嚴重的代償性出汗 反而比原來更加困窘)[/b]

In contrast, a second research team from Denmark reported a series of 100 patients who underwent surgery for underarm sweating.(丹麥也作了100位病患的調查報告)[/b]

Surgeons there routinely cut the T2 ganglia, and the study compared two groups who had either T2-T4 or T2-T3 resections. Approximately 90% of patients reported compensatory sweating, half of whom were forced to change their clothes during the day because of it.

(外科醫師大部份都作第二節交感神經切除 約90% 反應有代償性出汗,半數的人白天必須代償性出汗而換衣服)[/b]

There was no difference between the two groups, leading investigators to conclude compensatory sweating is determined by the original site of sweating rather than the extent or site of the surgery.

xyz軟體補給站"We speculate that the risk of side-effects following sympathectomy in general depends more on the primary location of hyperhidrosis rather than the extent of sympathectomy," said Dr. Peter Licht of Aarhus University Hospital. "It's been claimed to relate to the extent of sympathectomy, but our results fail to confirm this."
xyz軟體補給站
The frequency of compensatory sweating in the Danish study is more likely associated with their decision to cut the T2 ganglia in all patients, according to a Canadian surgeon who has performed more than 640 sympathectomies and has abandoned the T2 procedure because of unacceptable side-effects.(加拿大外科醫師 作了640個病患第二節交感神經切除手術 統計發現產生”無法接受的不良後遺症”後來加拿大外科醫師 不再作第二節交感神經切除手術)[/b]

"I had to do a number of reversals in that group," said Dr. Ernie Spratt of St. Joseph's Health Centre in Toronto. "I'm highly selective about who I will do now, and I won't do any type of cutting or cautery procedure.

" (我必須為那些(640個)病患作交感神經重建手術,我將”不再作任何”型式交感神經”切除”或者”燒灼”手術) (意即:加拿大外科醫師 誠實 懺悔認錯 並且願意為以往所作 錯誤手術作神經重建手術)[/b]
Dr. Spratt uses a clipping technique that can be reversed within six months of the procedure if severe compensatory sweating develops. He operates on only 35% of the patients referred to his office—most often on people with isolated hand, or hand and underarm sweating. The results in that patient group have been excellent, he said, and the key to his success is careful patient selection. For isolated underarm sweating he recommends sweat gland removal, but admits there are no good options for people with facial or scalp sweating.

"All I can say at this point is I don't think sympathectomy is the answer for that," he said. "They're very depressed when I see them, and I tell them I cannot recommend this procedure." (我只能說交感神經切除手術不是解決問題的方法 這些病人都非常沮喪 我不建議作這個手術)[/b]

Other complicating factors may include the type of procedure performed—cutting, excising or clipping—and the heterogeneity of the patient population. Little is known about the relationship between preoperative sweating and the success of sympathectomy. Both presenters in Tampa stressed the need for a large randomized clinical trial to determine best practices in sympathectomy for excessive sweating.




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