I. Definition of hand sweating disorder
Hand sweating is a common unexplained functional local abnormal hyperhidrosis, which is especially common in young people living in subtropical areas. Hand sweating is caused by unexplained abnormal excitation of the sympathetic nerves (e.g., nervousness, psychological stress, or summer heat), resulting in increased sweating on the palms of the hands, feet, head, neck, and chest and back. Initially, hand sweating was not considered a disease requiring surgical treatment, but with the need for social etiquette in modern society and the fact that excessive sweating is a problem for individuals, more and more people are taking this disease seriously and demanding active treatment.
Classification
Primary hyperhidrosis (PH) is a state of hypersecretion of sweat glands with no apparent cause, and is actually an autonomic functional disease of exocrine gland overproduction, most commonly in the palms, soles, and axillae, where sweating is often accompanied by cold palms, flushing of the face, or in severe cases, dripping hand sweat and purple face, presenting an extremely The embarrassing appearance of nervousness and anxiety.
Secondary hyperhidrosis is mostly caused by primary diseases (e.g., inflammation, tumors, injuries, etc.) affecting the peripheral vegetative nerves, such as lesions in the neck or chest that can stimulate the adjacent sympathetic nerve trunk and cause excessive sweating on one side of the body surface area. There are also some special types of localized hyperhidrosis, such as dietary hyperhidrosis (excessive sweating when eating warm or spicy foods) and olfactory hyperhidrosis (patients tend to have excessive sweating after sniffing specific odors).
The pathogenesis of hand sweating
In the current statistics of hand sweating cases, there are increased myelinated nerve fibers in the thoracic T2, T3, and T4 sympathetic ganglia, of which a large number of experiments have proved that the pathological change of myelin thickening is proportional to the nerve conduction speed, so the sweating rate of patients with hand sweating can reach 15ug/cm2 per minute clinically, i.e., it shows a large amount of sweating in a short period of time, therefore, theoretically, clamping or cutting off the relevant Therefore, theoretically, clamping or cutting the relevant sympathetic nerve can be an effective treatment for hand sweating.
IV. Classification and quantification of hand sweating disorder
The grading criteria of Lai et al. are simple and practical, with clear indications for surgery in moderate to severe cases.
The quantitative criteria are mostly applied to the judgment of postoperative efficacy and follow-up observation, and patients can self-rate according to the following table.
V. Minimally invasive surgical treatment of hand sweating
Endoscopic thoracic sympathectomy (ETS) is a minimally invasive surgical method for the treatment of hand sweating, in which a needle-type thoracoscope and an electrocoagulation hook are placed through 1-2 incisions of less than 1 cm on either side of the axilla to electrocautery the T2-4 or T3-T4 thoracic sympathetic nerve trunk for treatment purposes.
ETS is safe and reliable, with fast postoperative recovery and satisfactory and long-lasting results. It can be done bilaterally at the same time and is the only effective minimally invasive method for hand sweating. Because of its small trauma, light pain, and quick recovery, it can be discharged from the hospital within 24 hours of observation and can resume normal study and work in 3-5 days after surgery. Almost 100% of the patients can achieve immediate results after the operation, the sweating on the palms and axillary areas will stop immediately, and the temperature of the palms will increase, and the sweating on the feet will disappear in 30-50% of the patients.
In addition, according to the latest clinical observation, up to 95.7% of patients will develop compensatory hyperhidrosis (CH) in different parts of the trunk besides the palms, mainly in the chest and back, buttocks and lower extremities, and our observation concludes that compensatory hyperhidrosis is mostly unavoidable, but most patients have mild symptoms, which will generally be improved and reduced within six months. The mechanism may be related to postoperative thermoregulation and autonomic disturbances.
The incidence of compensatory hyperhidrosis after ETS is high, and patients need to be considered carefully before surgery, and only those who are willing to assume the possibility of compensatory hyperhidrosis after surgery are recommended to perform the surgery, so as to avoid patients’ sense of regret and complaints after surgery due to high preoperative psychological expectations.