ObjectiveTo investigate the causes of postoperative recurrence in patients with palmar hyperhidrosis and summarize the experience of reoperation. MethodsClinical data were collected from patients who experienced recurrence after surgical treatment for palmar hyperhidrosis at other hospitals between 2020 and 2023, and were admitted to the First Affiliated Hospital of Fujian Medical University. All patients underwent endoscopic thoracic sympathectomy (ETS) using a two-port thoracoscopy technique under artificial pneumothorax. The causes of recurrence and outcomes of reoperation were analyzed. ResultsA total of 36 patients (15 males, 21 females) with an average age of (28.25±6.14) years were included. The operative duration was 24-47 (31.04±21.09) minutes. No intraoperative bleeding, postoperative pneumothorax, or Horner's syndrome occurred. Two patients required intraoperative placement of closed thoracic drainage tubes due to severe pleural adhesions. All patients were discharged uneventfully on postoperative day 1. Intraoperative findings revealed the following primary causes of recurrence: incomplete transection of the sympathetic trunk, actual transection level lower than documented during initial surgery, failure to transect adjacent vessels paralleling the nerve trunk, insufficient resection range of lateral branches, and distance between nerve stumps <1 cm. At 1-year follow-up, all patients maintained bilateral hand dryness without recurrence, achieving a 100.0% efficacy rate. However, 15 patients developed new-onset or worsened compensatory hyperhidrosis compared to preoperative status. ConclusionETS is a safe, feasible, and effective treatment modality for recurrent palmar hyperhidrosis.
Compensatory hyperhidrosis (CH) is a severe side effect that occurs after endoscopic thoracic sympathotomy (ETS) for the treatment of palmar hyperhidrosis. CH significantly interferes with daily activities such as work, study, and social interactions, leading to a substantial decrease in the quality of life for patients. Preventing and treating CH are currently important and challenging issues in minimally invasive surgery for palmar hyperhidrosis. In this report, we presented a 29-year-old male patient who experienced severe CH for 8 years following ETS. The patient underwent staged unilateral endoscopic expanded sympathotomy (ES) at our hospital on December 11, 2023 and January 3, 2024, targeting the R4-R10 levels. After a 3-month follow-up, the patient experienced significant improvement in clinical symptoms and quality of life, with no recurrence of palmar hyperhidrosis or other complications. The treatment outcome was satisfactory.
ObjectiveTo explore the feasibility and safety of using indocyanine green combined with autologous blood and methylene blue for localization of small lung nodules during thoracoscopic wedge resection. MethodsPatients who underwent CT-guided percutaneous lung puncture injection of localization agents to locate lung nodules at the First Affiliated Hospital of Fujian Medical University from November 2023 to January 2024 were selected. Under thoracoscopy, lung nodules were located by white light mode, fluorescence mode, or near-infrared mode and wedge resection was performed. The feasibility of using indocyanine green combined with autologous blood and methylene blue for localization of small lung nodules was preliminarily verified by evaluating whether the localization agent concentrated around the nodules, and the safety of this method was verified by analyzing the incidence of adverse reactions during patient puncture and surgery. ResultsA total of 30 patients with lung nodules were included, including 10 males and 20 females, with an average age of (55.5±11.2) years. In 26 patients, the amount of localization agent used was moderate, the localization agent concentrated around the nodules, and successful precise localization of small lung nodules was achieved. In 4 patients, due to excessive use of localization agent, the marker was diffuse with pleural staining. The overall localization success rate was 86.7%, and when the injection volume of localization agent was 0.2-0.5 mL, the localization success rate was 100.0%. All patients successfully completed thoracoscopic wedge resection and found nodule lesions, with negative margins and a distance from the margin to the lesion that met the requirements. There were no complications. ConclusionThoracoscopic surgery using indocyanine green combined with autologous blood and methylene blue for localization of small lung nodules is safe and feasible.
ObjectiveTo investigate the prognosis and satisfaction of the R2 intervention procedure and develop related predictive models. Methods The clinical data of 64 patients with primary craniofacial hyperhidrosis who underwent R2 intervention surgery at the First Affiliated Hospital of Fujian Medical University from November 2018 to October 2022 were retrospectively analyzed. By statistically analyzing the risk factors for compensatory hyperhidrosis (CH) and satisfaction, and conducting feature screening, a relevant prediction model was established. ResultsFinally, 51 patients were collected, including 43 (84.3%) males and 8 (15.7%) females, with an average age of (30.27±7.22) years. Overall postoperative satisfaction was high, with only 5.9% of patients expressing regret about the surgery. However, 92.2% of patients experienced CH. The onset of postoperative CH was most prominent within the first 3 months postoperatively, with the incidence rate stabilizing thereafter. Preoperative heart rate and R2 sympathetic nerve clipping were identified as independent risk factors for severe CH. The preoperative body mass index, the degree of sweating in the chest and abdomen, are significantly correlated with postoperative satisfaction. Conclusion The R2 intervention surgery effectively alleviates the symptoms of primary craniofacial hyperhidrosis, and patient satisfaction is high.