Hyperhidrosis, especially sweating in exposed areas of the body, such as the hands, armpits and head and face, seriously affects the normal life of many people. In fact, this is often a pathological condition, medically known as “hand sweating”, “head and face hyperhidrosis” or “axillary sweating”. It seriously affects the quality of life of this group of people.
Because of the tension or noise when the head and face sweating and afraid to show their heads in public social occasions, afraid to go on stage speech; because of the serious sweaty palms and afraid to shake hands with others, or ashamed to hold hands with lovers; armpit sweating wet clothes so that young girls embarrassed; writing sweat wet paper; operating computer sweat wet keyboard; …… where this are These are the woes of such friends.
It can be said that because of these exposed parts of the sweat seriously affect their emotions, social, career choice and even marriage. Especially in recent years, as people’s standard of living has improved and their quality of life has increased, more and more people are seeking medical attention for this condition.
There are no exact statistics on the incidence of hyperhidrosis in the Chinese population. A foreign population-based statistic shows that the prevalence of various degrees of hyperhidrosis in various areas is between 6 per 1,000 and 10 per 1,000. Of these, 1/4, or 1.5 to 2.5 per cent, are hyperhidrosis of the hands. Forty percent of patients with hyperhidrosis have a genetic predisposition.
Traditional treatment of hyperhidrosis
Most cases of hyperhidrosis have no clear cause unless there is a clear underlying condition such as hyperthyroidism, excessive obesity, or neurosis that can be accompanied by hyperhidrosis. Because the pathogenesis of hyperhidrosis is unknown, there are a variety of treatments for hyperhidrosis. Traditional treatments include biofeedback, hypnotherapy, psychotherapy, sedation, anticholinergic receptor drugs, Chinese herbal medicine, topical astringent treatment of the skin at the sweating site, or radiation therapy.
However, all these treatment methods do not have very certain therapeutic effects. The long history of unsatisfactory treatment results has led many people to fear and various incorrect interpretations of this condition. Some people believe that it is a genetic problem that cannot be treated; others believe that it means their body is “weak” and take a lot of “supplements” for this reason, but in the end it is basically useless;
There are some people who believe that because they are introverted and timid, they will appear to be sweating profusely when they get to the lectern or other public places. Whether or not this is correct, it does add to the psychological burden of these sweaty friends.
The history of sympathectomy and the current status of its implementation in Japan and abroad
Sympathectomy for hand sweating first appeared in 1920. Due to the special anatomical location of this structure, the surgery could only be done by open-heart surgery at that time, which was obviously very traumatic. Therefore, this method was not widely accepted by patients and physicians at that time. However, since this procedure of removing the sympathetic nerve chain did provide a definite cure for excessive sweating of the hands, the procedure was not abandoned, and the quest to improve it and make it more minimally invasive began.
The supraclavicular incision, paraspinal incision, axillary incision, etc. have been invented, but they have not significantly reduced the surgical trauma, but rather increased the number of possible surgical complications. It has also been proposed to treat hand sweating by disrupting the sympathetic nerve chain through extracorporeal injection of some special drugs. Although this approach is much less invasive, an important problem is that the efficacy is very uncertain, because it is difficult to accurately reach the desired nerve segment by extracorporeal puncture.
The advent of televised thoracoscopic techniques in the 1990s gave a light in the darkness to the exploration of this surgical approach. This is a modern medical technology based on television imaging and cold light source technology. Through a small 0.5 cm incision in the chest wall and a TV thoracoscope placed in it, the surgeon can clearly see the sympathetic nerve chain located in the paraspinal column, and through another small incision of the same size and some special instruments, he can perform the procedure of removing or cutting the sympathetic nerve chain.
The technical simplification of this procedure, made possible by modern technology, has led to a tenfold or even a hundredfold increase in the number of cases performed worldwide in the last decade or so. In recent years, hundreds of articles have been published internationally on this procedure each year, involving tens of thousands of cases. The use of televised thoracoscopy has made this procedure a truly mature and routinely performed technique. It has completely replaced resection as the current standard procedure.
The basic method and problems associated with televised thoracoscopic sympathetic chain dissection
Patients need to be hospitalized for 3-4 days, and some necessary tests (routine blood, liver and kidney function, coagulation function, ECG, chest X-ray, etc., (equivalent to a systematic physical examination) are done before surgery. The operation is performed under general anesthesia, and a small incision of 5-10 mm is made in a hidden location under the armpit. Once the thoracoscope is placed inside, the surgeon can see the inside of the chest cavity and the sympathetic nerve chain located next to and parallel to the spine through a TV screen. With some special instruments, the surgeon is able to cut the sympathetic chain in less than 5 minutes.
After the surgery on one side, the other side is operated using the same method. The total operation time is less than half an hour. The patient is able to move around the same afternoon after the surgery. The patient can be discharged from the hospital the next day and can return to work in 2-3 days, leaving little or no scar on the chest wall after the stitches are removed. Even if there is some scarring, it will not affect the aesthetics because it is located in a hidden location like under the armpit.
Surgical effectiveness, safety and possible complications.
The improvement rate of hand sweating can reach 98%-100%, the improvement rate of head and face hyperhidrosis is over 90%, and the efficiency rate of axillary sweating is 75-80%. The surgery is minimally invasive and is generally safe. There are some long term side effects after surgery, the most common being compensatory sweating in other parts of the body, a complication that is now very low in experienced centers with very mild symptoms. In addition, a small percentage of patients experience a slightly slower surgical heart rate, but this generally does not interfere with normal life and physical activity. Some patients have chapped surgical hands from excessive sweating and sometimes need to apply some skin oils.
Social and medical factors that influence people to choose this procedure
Although this procedure has been available since the 1920s, it has not been widely used historically, mainly because of the high level of trauma, and since the 1990s it has been increasingly reported and accepted by more and more people as a result of the radical solution to the problem of surgical trauma with televisual thoracoscopy and the increased demand for quality of life. Even so, there are still many people who suffer from excessive sweating who cannot undergo such a procedure in time. There are a number of social and medical factors involved.
(1) Due to traditional beliefs, many people do not realize that excessive sweating of the hands and head is a separate and thoroughly treatable condition, so they “suffer in silence” for a long time without going to the doctor for treatment.
(2) Many patients with hand sweating or head and face hyperhidrosis do not know which department they should go to for treatment, often thinking first of dermatology, neurology or internal medicine, and doctors in these departments are often unaware of the sympathetic nerve chain severing procedure, making it impossible for these patients to receive timely and accurate treatment.
(3) Thoracic surgery thoracoscopic surgeon is the competent doctor to carry out this procedure, and the doctor’s experience in thoracoscopic surgery is the key to ensure the safety of the procedure and influence the success or failure of the procedure. However, most patients, even if they are aware of this procedure, do not know that they should seek treatment for diseases such as hand sweating and head sweating from a thoracic surgeon.
This situation of “patients not finding the right doctor and doctors not meeting the right patients” is the main bottleneck that limits the widespread use of this procedure.
Hyperhidrosis is a new disease that people encounter in modern society to improve their quality of life and social life after meeting the basic needs of survival; and TV thoracoscopic sympathetic nerve chain dissection is a new technology that emerged after the improvement of traditional surgery by modern technological progress, how to let this new problem be solved from this new technology, i.e., how to let modern people who are interested in improving their quality of life benefit from modern technology. This is an important responsibility of the science popularizers and the media.