1998 Aug 26;95(35):3660-2.
of facial blushing with endoscopic thoracal sympathicotomy. 85 per
cent of patients are satisfied, but there are adverse effects]
G, Drott C, Dalman P, Rex L, Gothberg G, Fahlen T.
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.
PMID: 9748777 [PubMed - indexed for MEDLINE]
Journal of Cosmetic Dermatology（美容皮肤病杂志）
Volume 1 Issue 3 Page 115 - October 2002
Facial blushing treated by sympathetic denervation - longlasting
benefits in 831 patients
Drott, Göran Claes, and Lars Rex
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
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.
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
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
Mental Health Care
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.
of life evaluation following endoscopic transthoracic sympathectomy
for upper limb and facial hyperhydrosis.
Ann Chir Gynaecol
Hillingdon Vascular Unit,
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.
Experience of Endoscopic Thoracic Sympathicotomy for Palmar,
Axillary, Facial Hyperhidrosis and Facial Blushing
Olsson Rex, Christer Drott, Go¨ran
Claes, Gunnar Go¨thberg
and Peter Dalman
the Department of Surgery, Bora°s
J Surg 1998; Suppl 580: 23–26
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.
words: thoracoscopy, sympathectomy, hyperhidrosis, facial blushing.