刊名:Lakartidningen. 1998 Aug 26;95(35):3660-2.
文题:[Treatment of facial blushing with endoscopic thoracal sympathicotomy. 85 per cent of patients are satisfied, but there are adverse effects]

原文文字:[Article in Swedish]

作者:Claes G, Drott C, Dalman P, Rex L, Gothberg G, Fahlen T.

Kirurgiska kliniken, Boras lasarett.
Endoscopic transthoracic sympathicotomy, otherwise an established treatment for palmar hyperhidrosis, was used to treat patients troubled by facial blushing, one of the commonest symptoms of social phobia. The results were evaluated by means of a questionnaire answered by 90 per cent (219/244) of the patients, who rated their symptoms on a visual analogue scale (0-10) after a mean follow-up of eight months. According to the ratings, blushing was significantly reduced from a mean (+/- SEM) of 8.7 +/- 0.1 to 2.2 +/- 0.2 (p < 0.0001). Of the series as a whole, 85 per cent declared themselves satisfied with the outcome.
索引号: PMID: 9748777 [PubMed - indexed for MEDLINE]

Journal of Cosmetic Dermatology
Volume 1 Issue 3 Page 115  - October 2002
Facial blushing treated by sympathetic denervation - longlasting benefits in 831 patients

Christer Drott, Göran Claes, and Lars Rex

Background 背景
Severe facial blushing may have a strong negative impact on the quality of life and is one of the cardinal symptoms of social phobia. If traditional therapeutic options such as psychotherapy and pharmacological treatment fail, interruption of the sympathetic innervation to the face offers good results.

To investigate whether endoscopic thoracic sympathecotomy (ETS) remains an effective treatment of facial blushing more than one year's follow up.

1314 consecutive patients with severe facial blushing were treated with bilateral ETS. The results were evaluated by questionnaire and symptoms assessed with visual analogue scales (0-10).

The questionnaire was completed by 831 patients (63%) a mean of 29 months (
± 11 days) after surgery. Facial blushing was reduced from 8.8 ± 0.05 to 2.5 ± 0.09, P< 0.0001 by the operation. The quality of life was substantially improved. The main side-effect was redistribution of sweating from the upper to the lower part of the body (compensatory sweating). Increased sweating of the trunk occurred in 83% of the responses. Overall, 85% of the respondents were satisfied with the result and 15% were to some degree not satisfied.
收回问卷831份(63%),平均术后时间29月(加减11天)。颜面潮红程度的改善情况为8.8 ± 0.05 to 2.5 ± 0.09, P< 0.0001。生活治疗得到了实质性改善。主要的副作用为汗在身体上下的重新分布(代偿性出汗)。83%的患者有躯干部位的出汗。85%的患者对手术效果满意。15%的患者对手术效果有不同程度的不满意。

As this is an open study and 37% of patients did not respond to the questionnaire, the results must be viewed with caution. ETS, however, appears to be an effective, safe and lasting surgical method for the treatment of severe facial blushing. Side-effects, especially compensatory sweating on the trunk and legs are common, and may be severe but only rarely result in the patient regretting the operation.



The role of the sympathetic nervous system in anxiety: Is it possible to relieve anxiety with endoscopic sympathetic block?
J Nord J Psychiatry 2003 ; 57(1):55-60

Tampere City Mental Health Care Centre , Finland . paivi.pohjavaara@fimnet.fi

The function of the autonomic nervous system is divided so that the parasympathetic system spares central nervous system energy and the sympathetic system makes extra energy available and consumes it. The sympathetic nervous system then prepares our body for emergency and it always functions when our conscious or even unconscious mind notices a need for defence or to provide energy. A surgical procedure, where the upper thoracic sympathetic ganglions are ablated, either with cauterization or clamping with metallic clips, has been used to treat sweating of the hands and facial blushing for decades. Instead of ablating large areas of sympathetic trunk, which can cause severe side-effects such as reflex sweating of the body, the surgical procedure is nowadays carried out in a more precise symptom-mediating level of uppermost thoracic sympathetic ganglia. Blushing, hyperhidrosis of palms and head, and trembling are common in social phobia, and they seem to be provoked by the activation of the sympathetic nervous system. Preliminary studies show that some social phobia patients may benefit from the endoscopic sympathetic block (ESB). If the patient with generalized social phobia has not received help with adequate medication or psychotherapy, the ESB may be a new possible treatment of choice. 





Quality of life evaluation following endoscopic transthoracic sympathectomy for upper limb and facial hyperhydrosis.

J Ann Chir Gynaecol

The Hillingdon Vascular Unit, Hillingdon Hospital , Imperial College , London , UK .

In this prospective cohort study, the outcome of bilateral endoscopic transthoracic sympathectomy (ETS) was assessed using the Dermatology Life Quality Index (DLQI) questionnaire. 10 consecutive patients who underwent two-stage bilateral ETS for primary hyperhydrosis were assessed. Two patients had concomitant facial blushing. Symptomatic improvement was achieved in all patients. Statistical analysis (one-tailed Wilcoxon rank test) demonstrates a significant (p < 0.05) step-wise improvement in quality of life after each stage. This has not previously been described for two-stage bilateral ETS and confirms the suitability of this technique in the definitive management of refractory primary hyperhydrosis.




The Bora°s Experience of Endoscopic Thoracic Sympathicotomy for Palmar, Axillary, Facial Hyperhidrosis and Facial Blushing

Lars Olsson Rex, Christer Drott, Go¨ran Claes, Gunnar Go¨thberg and Peter Dalman

From the Department of Surgery, Bora°s Hospital, Bora°s, Sweden

Eur J Surg 1998; Suppl 580: 2326

Objective: To study the outcome of endoscopic thoracic sympaticotomy (ETS) for palmar, axillary, facial hyperhidrosis and facial blushing.Subjects: 1152 patients, 59% women and 41% men.Intervention: ETS was performed by transection of the sympathetic chain where it overlies the second and hird rib. The nerve was divided also over the fourth rib in patients with illary hyperhidrosis. Questionnaires were sent to all patients.
Main outcome measures: The effect of surgery was assessed by a 10 grad visual analogue scale (VAS) by the patients. The results were divided into effect rate (the effect on the symptom) and overall satisfaction rate, taking into account any side effects and complications apart from the effect.Results: The response rate was 90%. The mean follow up time, effect rate and overall satisfaction rate were: 38 months for palmar hyperhidrosis, 99,4% and 87%; 26 months for axillary hyperhidrosis, 94,5% and 68%; 31 months for facial hyperhidrosis, 97% and 76%;
8 months for facial blushing, 96% and 85%.Conclusion: ETS is a very effective procedure in palmar, axillary and facial hyperhidrosis and facial blushing. The overall satisfaction rate is very good for palmar hyperhidrosis and facial blushing, not equally good but acceptable for facial hyperhidrosis. The lower satisfaction rate in patients with axillary hyperhidrosis makes this a questionable indication for ETS.

Key words: thoracoscopy, sympathectomy, hyperhidrosis, facial blushing.



国内文献资料         实际病例术前术后照片