中文摘要：

目的：探讨胸交感神经链切断术治疗手汗症是否需要附加切断胸交感神经链旁路纤维。方法分析2009年1月至2011年6月福建医科大学附属第一医院重度手汗症患者200例，随机分成胸3交感神经链切断（ R3）组，胸3交感链加旁路纤维切断（ R3＋）组各100例，经术后疗效观察及3年随访进行对照研究。结果两组术后双手及腋窝多汗改善有效率均为100％。 R3组与R3＋组比较，胸交感神经链切断前后左手温升幅[（3．6±1．4）℃比（3．5±1．3）℃]、右手温升幅[（3．8±1．3）℃比（3．9±1．1）℃]、术后代偿性多汗发生率（40％比44％）、复发率（1％比2％）、满意度（92％比90％）等差异无统计学意义，但术后疼痛评分R3组低于R3＋组[（3．0±1．9）比（3．6±1．9）分，P＜0．05]，差异有统计学意义。结论胸腔镜胸交感神经切断术单纯切断交感神经链即可，没有必要旁开切断旁路纤维。

英文摘要：

Objective To explore the necessity of interrupting nerve fibers of bypass thoracic sympathetic chain during edoscopic sympathicotomy （ ETS ） for palmar hyperhidrosis.Methods Randomized controlled trial was performed for 200 patients of severe palmar hyperhidrosis from January 2009 to June 2011.They were randomly divided into 2 groups of R3 thoracic sympathctomy （R3） and R3 thoracic sympathicotomy plus bypass fiber resection at the same level （R3＋） （n=100 each）.Clinical observations were recorded during a follow-up period of 3 years.Results The curative rates of palmar and axillary hyperhidrosis were 100%for two groups.No statistically significant inter-group difference existed in left hand temperature increase after transecting thoracic sympathetic nerve（3.6 ±1.4℃vs 3.5 ±1.3℃）,right hand increase （3.8 ±1.3 ℃ vs 3.9 ±1.1 ℃）,incidence of compensatory hyperhidrosis （40% vs 44%）, recurrence rate （ 1% vs 2%） and postoperative satisfaction rate （ 92% vs 90%） .But pain scores of R3 group was significantly lower than those of R3 ＋group （3.0 ±1.9 vs 3.6 ±1.9,P〈0.05）.Conclusion Simple transaction of thoracic sympathetic chain during ETS is sufficient in the treatment of palmar hyperhidrosis.And it is unnecessary to transect bypass fibers.