1.What is hand sweating syndrome?
2.What are the clinical manifestations of hand sweating?
3.Does hand sweating cause any harm to people?
4.What is the diagnosis process of hand sweating?
5.What are the treatment options for hand sweating?
6.How does thoracoscopy treat hand sweating?
7.What are the advantages and disadvantages of thoracoscopic treatment?
8.What is compensatory hyperhidrosis?
9.Why do we need to develop new technology for the treatment of hand sweating?
10.What is the principle of thoracic sympathetic block in the treatment of hand sweating?
11.How does thoracic sympathetic block work in the treatment of hand sweating?
12.What are the advantages and shortcomings of thoracic sympathetic block in the treatment of hand sweating?
13.Does thoracic sympathetic block have any risk in treating hand sweating? What are the precautions?
14.Does thoracic sympathetic block require hospitalization for the treatment of hand sweating? How much does it cost?
15.How to consult and contact for treatment?
1.What is hand sweating?
Simply put, hand sweating is a symptom of excessive hand sweating, accounting for 0.6% to 1% of the total population.
Sweating is a normal heat dissipation response of the body, controlled by the sympathetic nerves in the vegetative nervous system. When the ambient temperature or body temperature exceeds the body’s own body temperature set point, the sympathetic nerves become active to prevent the body temperature from rising further, dominating the body’s sweat gland secretion and evaporating through sweat to take away heat to cool down.
Sweating varies from person to person. At the same ambient temperature, some people sweat more and some people sweat less. However, when the ambient temperature is not high and sweating is not normally needed to dissipate heat, but still sweating profusely, it is called “hyperhidrosis”.
Hyperhidrosis is divided into two categories: primary hyperhidrosis and secondary hyperhidrosis.
Primary hyperhidrosis is a state of hypersecretion of the sweat glands with no apparent cause, and is actually a functional autonomic disorder in which the sweat glands are overproducing. Secondary hyperhidrosis is caused by a number of neuroendocrine and other systemic diseases (such as hyperthyroidism, diabetes mellitus, hypoglycemia, poisoning, drug side effects, cardiovascular disease, respiratory failure, carcinoid syndrome, Hodgkin’s disease) that cause excessive sweating.
Hyperhidrosis can be divided into generalized hyperhidrosis and localized hyperhidrosis according to the location of sweating. Generalized hyperhidrosis is mostly secondary hyperhidrosis, while localized hyperhidrosis is mostly primary hyperhidrosis.
Hand sweating is actually a primary localized hyperhidrosis and is known to be caused by hyperactivity of the thoracic sympathetic nerve, which governs the secretory function of the sweat glands in both hands.
The actual fact is that it is a primary localized hyperhidrosis that is known to be caused by excessive activity of the thoracic sympathetic nerve that governs the sweating function of the hands.
2. What are the clinical manifestations of hand sweating?
The main manifestation of primary hand sweating is excessive sweating on the palms of the hands, which is not affected by external temperature. The sweating is usually accompanied by cold palms, and only in a few cases are the fingers kept warm during sweating. In some cases, sweating of the feet or sweating of the head, face, or armpits is also associated with sweating.
Sweating is highly correlated with emotional activity, and sweating is more frequent when the mind is under stress. The onset of symptoms is sudden and intermittent, with each episode lasting 5 to 30 minutes and the number of episodes per day varying, but sweating is rare during sleep. Most patients have more severe symptoms in summer and less severe symptoms in winter. In some patients, hand sweating is a frequent occurrence when sweating is thought of, and is much less associated with ambient temperature than with mental activity.
Furthermore, hand sweating often manifests as follows.
A. Plantar sweating: 40% to 45% of people with hand sweating have sweaty soles at the same time, and foot sweat is more likely to accumulate, even if frequent changes of shoes and socks do not remove sweat and its odor in time. Therefore, the soles of the feet are most likely to have secondary skin lesions, such as dermatitis, tinea pedis, skin keratosis off, skin herpes, etc.
B. Axillary sweating: 25%-30% of people with sweaty hands have sweaty axillae, and sweat easily penetrates clothes, and their axillary areas are large sweat patches. Because of the secrecy of the armpit area is also easy to cause the skin bacteria or fungal infection, serious cases of skin erosion.
C. Facial sweating: The combined head and facial sweating accounts for 1% to 5%. Most patients also have facial flushing, and in heavy cases, the face is purplish-red, presenting a nervous and embarrassing appearance.
D. Hands and feet are prone to frostbite: hand and foot sweating is mostly “wet and cold”, and the temperature of the hands and feet is only about 33°C, 2 to 3°C lower than that of those without sweating, thus making them prone to frostbite in winter. Because the hands and feet are often in a state of sympathetic excitation of the constricted blood vessels, hands and feet are often ischemic blue-gray. The hands and feet are often immersed in sweat, and often appear “peeling” phenomenon, occasionally sweat herpes (hands and feet sweating when the sweat duct mouth blockage caused by sweat stored in the palm and toe skin of an eczema-like changes) appear.
In short, primary hand sweating symptoms are typical, the diagnosis is not difficult, but finally to the regular hospital consultation to exclude secondary sweating, symptomatic treatment.
3. Is there any harm to people with hand sweating?
Hand sweating is only a relative excitation of the sympathetic nerves in the human body, and is not harmful to health.
However, due to sweaty palms, soles and armpits, it often causes a lot of inconvenience to learning, working, living and social activities. For example, when students take exams because the hands sweat a lot easily wet test papers, when operating a computer sweat wet keyboard, when working as an electrician moisture easy electrocution, social interaction because of the palms of the serious sweaty hands and afraid to shake hands with others ……, and so on, indeed bring some trouble to work life.
4. What is the diagnosis process of hand sweating?
The diagnosis of hand sweating is relatively easy, the key is to distinguish primary hand sweating from secondary hyperhidrosis.
A. Key points of history taking.
(1) Determine the exact site of hyperhidrosis and determine whether it is localized or generalized hyperhidrosis.
(2) Frequency and duration of episodes of sweating.
(3) Age of onset.
(4) Family history.
(5) Whether there are systemic symptoms such as fever, night sweats and weight loss.
(6) Whether excessive sweating is associated with emotional activity.
(7) Impact on social, occupational, and daily life conditions.
(8) Exclude other symptoms of secondary hyperhidrosis.
B. Physical examination.
In cases of primary localized hyperhidrosis, only the manifestations of abnormal sweating and positive signs of secondary skin lesions are usually found: such as palmar desquamation, sweat rash, frostbite, etc.
Note that some positive signs are found that facilitate the differential diagnosis with generalized hyperhidrosis. For example, wasting may suggest chronic systemic wasting disease, acromegaly may be related to endocrine system disease, those with accelerated heart rate should further exclude the possibility of hyperthyroidism, and those with elevated blood pressure should pay attention to exclude pheochromocytoma.
C. Ancillary tests.
The examination before the diagnosis of hyperhidrosis should also include routine blood and urine examination, as well as the determination of blood glucose, T3 and T4 concentrations. In addition, X-rays or chest CT examinations can exclude the presence of lesions such as tuberculosis in the chest.
CT chest examination should be performed to exclude pleural hypertrophy and other lesions if surgical treatment is planned. In cases where systemic disease is suspected, relevant tests should be performed, such as urine catecholamine derivatives for suspected pheochromocytoma.
5. What are the treatment options for hand sweating?
There are a variety of treatments for hand sweating, the most common of which are six types of methods.
① Topical lotions.
Topical lotion is mainly applied with astringent alum, glutaraldehyde and other solutions soaked for tens of minutes, which can have certain effect within a few days, but skin damage of the hands will occur, wrinkling, cracking and other skin lesions, and the effect is not lasting.
②Oral use of anticholinergic antiperspirant.
Systemic use of anticholinergic drugs such as ursodiol can inhibit sympathetic nerve activity to a certain extent, resulting in a relative reduction in sweating, but relapse upon discontinuation of the drug, and complications such as dry mouth and rapid heartbeat often occur during the use of the drug.
③Anxiolytics for oral use
The episodes of sweating in primary hand sweating are often triggered by emotional activity, especially when the spirit is tense, while sweating does not occur after sleep. For this reason, sedative anti-anxiety drugs can have a certain therapeutic effect. Commonly used drugs are tranquilizers: Valium tablets, Xuloxane tablets, Imipramine tablets, Synthroid tablets, anxiolytic Amitriptyline tablets, Prozac, Dalixin, etc. But sedative anti-anxiety drugs often cause mental depression, tiredness, inattention. The long time to take also appears drug dependence, and therefore less used in the treatment of hand sweating.
④ Local injection of carnitine.
Carnitine palm surface skin injection within the injection can make the injection site to stop or reduce sweating within 1~3 months. However, this method is painful, requires multiple injections, repeated injections, and is prone to complications such as palmar surface infection, and costs high Pleiades, each hand injection treatment costs nearly $1,000, and can only be effective for 1~3 months.
⑤ Surgical treatment.
Traditional open-chest surgery to cut off the thoracic sympathetic chain to treat hand sweating began in 1954, by Kux first open-chest resection of T2 to block sweat gland secretion was successful, but because of the huge open-chest trauma, promotion difficulties (the traditional surgical approach is to cut from the center of the back and remove the second and third sympathetic ganglion on both sides, this method of surgery time, recovery time is long, risky, there is a postoperative wound of about five to seven centimeters)
Since the use of Endoscopic Thoracic Sympathectomy (ETS) in 1992, this procedure has become the “gold standard” for the surgical treatment of hand sweating: one to three small incisions in each side of the axilla, each about 1 to 2 cm. The operation time and recovery period is shorter than traditional open-heart surgery, and the pain is also lighter than traditional surgery, but the operation still requires general anesthesia, and the cost is higher (more than 10,000 yuan). At present, this procedure is more carried out in China and the technology is more mature, and it can be basically carried out in tertiary hospitals with thoracoscopy everywhere.
(vi) Minimally invasive interventional treatment —- CT-guided percutaneous percutaneous thoracic sympathetic nerve block.
This technique is a new, more minimally invasive treatment for hand sweating developed by Jiaxing First Hospital in 2009. No incision or general anesthesia is required, and two fine needles are punctured from behind to the vicinity of the sympathetic nerve under CT guidance, and 2 ml of anhydrous alcohol is injected to cure the hand sweating.
The new method is nearly non-invasive, and good treatment can walk as usual, and the cost is only about 4,000 yuan. It has cured a group of patients from Shaanxi, Hubei, Xinjiang and Jiaxing local, and has been reported in Nanhu Evening News (May 30), Jiaxing Daily (June 1) and Health News (June 15), and is a more promising method.
6.How does thoracoscopy treat hand sweating?
Although the exact mechanism of primary hand sweating has not been fully understood, it is clear that excessive thoracic sympathetic nerve activity is directly related to the occurrence of hand sweating. The effectiveness of cutting the thoracic sympathetic nerve chain in the treatment of hand sweating has been clinically proven.
Following conventional open-heart surgery to cut the thoracic sympathetic nerve for hand sweating, televised thoracoscopic thoracic sympathectomy (ETS) has become a classic procedure for the treatment of hand sweating.
An anesthesiologist first administers general anesthesia to the patient with hand sweating and inserts a double-lumen tracheal tube to ensure that both lungs can be ventilated separately. The surgeon first makes one to three small incisions of about 2 cm in the relatively hidden area of the patient’s axilla, and the anesthesiologist controls the patient to ventilate one lung on the opposite side, while the lung on the operated side is completely atrophied, exposing the thoracic cavity completely. The electrocautery is performed on the thoracic sympathetic chain at T2 to T4 to sever the sympathetic chain at these locations. Subsequently, the hemorrhage is stopped, the lens is removed, the anesthesiologist bulks the lung, and a closed chest drain is placed, followed by the same method of severing the sympathetic chain in the contralateral thorax.
After the operation, the anesthesiologist stops the drugs and removes the tracheal tube when the anesthesia is fully awakened. The patient can speak after further resuscitation and can get out of bed after one day. Generally, the patient can be discharged from the hospital three days after surgery and the incision sutures can be removed in five to ten days.
After the thoracic sympathetic nerve chain is severed, the hand sweating phenomenon can disappear immediately and can be stopped for life. However, some patients will have compensatory hyperhidrosis after surgery, i.e. hand sweating does not occur anymore, but sweating in the chest, abdomen, waist and back and thighs is much more than before.
7.What are the advantages and disadvantages of thoracoscopic treatment?
The advantages of thoracoscopic treatment for hand sweating are
A. Compared with conventional open-heart surgery, thoracoscopic incision is small and trauma is significantly reduced, which is favorable to patients’ postoperative recovery.
B. TV thoracoscopy is performed by an instrument with a camera lens into the pleural cavity, and the situation of the pleural cavity is recorded on the TV screen at the side of the operating table, which is equivalent to cutting the thoracic sympathetic nerve under “bright vision”.
C. The operation is performed under general anesthesia in the operating room, and in the event of bleeding, pneumothorax and other complications, hemostasis and drainage can be performed at any time.
Shortcomings of thoracoscopic treatment of hand sweating.
A. Although it is much less traumatic than conventional open-chest surgery, it still requires 2~6 incisions, and the incisions need to be sutured after the operation, the postoperative pain is more intense, and it takes at least 5~15 days to recover to normal, and the incisions may also leave more obvious scars.
B. The surgery is performed under general anesthesia, a double-lumen tracheal tube is inserted, and intraoperative one-lung ventilation is required. Patients are at risk of carbon dioxide accumulation and hypoxemia, as well as other anesthesia-related risks.
C. There are relative contraindications. Thoracoscopic surgery must be performed through the pleural cavity. If the patient has pleurisy or pleural hypertrophy, adhesions, or other pleural cavity disease, thoracoscopic surgery will have to be abandoned because the thoracic sympathetic nerve cannot be exposed. That is, such patients cannot complete the procedure thoracoscopically. In addition, patients who are limited to the type of double-lumen tracheal tube, have a thin trachea or have tracheal stenosis will also be unable to receive thoracoscopic surgical treatment due to the difficulty of double-lumen tube insertion.
D. The procedure is risky and has more possible complications. Possible complications include hemothorax due to bleeding in the chest or pneumothorax due to rupture of lung membranes and alveoli. Very few patients will have Horner’s syndrome (mild drooping of the eyelids), a complication that affects the aesthetics but not the vision, and if this complication is permanent, cosmetic surgery will be required to correct it. Other potential dangers, as with any surgery, such as allergy to anesthetic drugs, are possible, and there are rare reports in the literature of injuries causing celiac disease and large blood vessels.
E. Postoperative compensatory sweating is a problem that has not yet been cracked in thoracoscopic treatment of hand sweating. After thoracic sympathetic nerve severance, the sympathetic nerve below the severed end loses downward inhibition from the higher center (brain), resulting in increased uncontrolled autonomic activity and thus a large increase in sweating in the abdomen, thoracic back, and both lower extremities, a complication that most patients can tolerate, but which more than 25% of patients find unbearable and may even regret having undergone surgical treatment. Although the compensatory sweating in many patients will gradually decrease with the prolongation of postoperative time, it also brings new troubles to some postoperative patients.
F. Special equipment is required, medical resources are occupied and medical costs are high. This treatment is necessary to have a TV chest unit to carry out, and the thoracoscopic equipment is mostly over one million yuan, and many tertiary hospitals do not have this equipment yet. When carrying out this operation, 5~8 medical personnel are required to participate at the same time, which takes up a large amount of medical resources. Together with the operation fee, anesthesia fee, and hospitalization fee, the cost of thoracoscopic thoracic sympathectomy for hand sweating is more than ten thousand yuan.
8.What is compensatory hyperhidrosis?
Compensatory hyperhidrosis refers to the condition of asymmetric hyperhidrosis of another part of the body surface after the absence of sweating in part of the body surface area due to lesion or surgery. Sympathetic trunk injury (including sympathectomy), spinal cord injury, and diabetic neuropathy can all cause compensatory hyperhidrosis.
Currently, it is believed that compensatory hyperhidrosis after thoracic sympathetic chain severance is due to the loss of downward inhibition of the sympathetic nerve below the severed end of the chain by the higher center (hypothalamus) and the abnormal increase in sympathetic activity.
This is reflected in an increase in sweating on the torso, especially on the back and thighs, after the surgery to release sweating on the palms of the hands and face. In addition, once thoracic sympathectomy is performed, if there is significant compensatory sweating after the surgery, it is impossible to restore the sweating to its original state before the surgery or by other means.
Thus, compensatory hyperhidrosis is also a yet-to-be-cracked problem in thoracoscopic surgery for hand sweating. While patients with mild to moderate compensatory hyperhidrosis are generally able to accept it after surgery, a few patients with severe compensatory hyperhidrosis do bring new and serious problems to their lives.
9. Why is it necessary to develop new techniques for the treatment of hand sweating?
Although the efficacy of thoracoscopic surgery for hand sweating is exact, it still has greater trauma and related complications and risks, plus it requires special equipment, takes up a lot of medical resources, and has high treatment costs, which also makes some of the less well-off hand sweat patients have to endure the inconvenience caused by hand sweating and cannot receive thoracoscopic surgery treatment.
In addition, postoperative compensatory hyperhidrosis is a problem that has not yet been solved by thoracoscopic surgery. This is because once the thoracic sympathetic nerve is disconnected by thoracoscopic electrocautery, it is very difficult to reattach it. In other words, if compensatory hyperhidrosis occurs after surgery, there is currently no way to solve this problem.
So can a more minimally invasive, economical and safe treatment technique be developed?
The answer is yes. Because the development of medical technology suggests that there is no end to the minimally invasive means of treatment, i.e., still any kind of treatment technology is only better, not the best. The replacement of traditional open-heart surgery by thoracoscopy is a better approach and has become the “gold standard” for the treatment of hand sweating, but it is also time-sensitive, i.e., thoracoscopic surgery is the best approach in this era, and there will certainly be better ways to replace it in the future.
The CT-guided percutaneous thoracic sympathetic nerve block technique for hand sweating is more minimally invasive, more economical, and can avoid or reduce the occurrence of compensatory hyperhidrosis, and is expected to become the next “gold standard” for the treatment of hand sweating after thoracoscopic surgery.
10.What is the principle of “CT-guided percutaneous thoracic sympathetic block” in the treatment of hand sweating?
For a nerve to work properly, it must have structural and functional integrity. Once the structure of a nerve is destroyed, it loses its basic function; similarly, if a drug is used to block the conduction of a nerve, it will lose its function even though its structure is intact. The simplest example is nerve block anesthesia (e.g., lumbar anesthesia or brachial from nerve block), in which a local anesthetic is administered to the subarachnoid space or near the brachial plexus nerve, allowing the drug to temporarily block the conduction function of the nerve, so the lower body or upper extremity is paralyzed, as if it were paraplegic. However, the local anesthetic is short-lived, wearing off in a maximum of 10 hours or so, and the function of the nerve is restored.
Unlike thoracoscopic thoracic sympathectomy, CT-guided percutaneous thoracic sympathetic block technique does not break the nerve, but blocks the function of the nerve. Only the short-acting local anesthetic is replaced with anhydrous alcohol that can be effective for a long time.
In other words, the thoracic sympathetic block technique preserves the structural integrity of the thoracic sympathetic nerve and achieves the goal of treating hand sweating by blocking the function of the nerve. That is, the activity of the sympathetic nerve is reduced by injecting anhydrous alcohol near the thoracic sympathetic nerve instead of cutting it off.
11.How does thoracic sympathetic block work in treating hand sweating?
After the diagnosis of primary hand sweating is confirmed, the patient’s platelets and bleeding and clotting times are checked, no coagulation dysfunction is present, and after obtaining the patient’s informed consent, an iodine allergy test is performed, and those who are negative are sent to the CT room after an intravenous cannula is left in place.
The patient was placed prone on the CT table, and a positioning grid was placed on the skin of the corresponding back of the thoracic 3 and 4 vertebral bodies (T3 and 4), and the T3-4 intervertebral space was accurately located with CT positioning images (as shown in Figure 1), and the upper and lower two vertebral bodies were scanned with a layer thickness of 3 mm centered on them to find and lock the exposed level above the costal tuberosity of the 4th rib (no ribs, articular processes, or laminae obscuring the CT outside the intervertebral foramen, which can be used for puncture The target point was the upper edge of the 4th rib joint (corresponding to the lower outer edge of the T3 vertebral body above the small head of the 4th rib, the best skin entry point on both sides was selected, and the distance between the entry point and the target point (entry depth), the entry angle, and the distance of the entry point from the midline were recorded with a CT tool ruler, and the distance between the CT bed and the frame shown at this level was recorded. The angle and relative distance between the CT bed and the frame are recorded.
Open the positioning red line, and mark both sides of the puncture entry points on the positioning red line with a marker according to the previously measured distance from the midline. After local anesthesia of the selected puncture point, the needle was punctured with a No. 7 radiofrequency needle under CT guidance according to the proposed angle and depth, which could be adjusted by CT scan again or several times during the needle feeding process until the needle tip arrived at the target point close to the upper edge of the 4th rib joint. The CT localization image is used again to confirm that the puncture needle is located at the outer edge of the T3 vertebral body above the T3-4 intervertebral space. The patient’s hands were dried of sweat, and palm temperature ( °C) was measured and recorded.
The retraction was free of blood, fluid and gas, and 3 ml of 1% lidocaine (containing 0.3 ml of contrast agent 30% iodophoresis injection) was injected at each point, and the CT scan showed that the injected solution covered the posterior outer edges of both sides of the T3 vertebral body and the spinal groove outside the small head of the 4th rib, and the upper edge of the solution reached just outside the wall pleura at the level of the 3rd rib joint (Figure 6, Figure 7, Figure 8, Figure 9). Observed for 25 min, the patient had no numbness and movement disorder in the lower extremities, no Horner’s syndrome bilaterally, and the palms of both hands had changed from wet and cold to dry and warm ( °C). The left and right were injected with 2.5ml of anhydrous alcohol each (each 1ml contained 0.9ml of anhydrous alcohol and 0.1ml of 30% iodophoresis injection), and after withdrawing the needle, CT was performed again to confirm that the alcohol was wrapped around the small head of the 3rd and 4th ribs and the lateral side of the T3 and 4 vertebrae outside the wall pleura, and the upper edge of the drug reached the lower edge of the T2 vertebrae .CT observation of the lung window, no hemothorax or pneumothorax could occur.
12.What are the advantages and shortcomings of thoracic sympathetic block in the treatment of hand sweating?
The advantages of thoracic sympathetic block in the treatment of hand sweating are
A. It is more minimally invasive. This technique can be done by sticking two fine needles into the back under the guidance of CT to inject drugs near the thoracic sympathetic chain, without surgery, without general anesthesia, without incisions, without scars, and the patient can get up and leave after treatment.
B. More economical. This technology only requires one imaging doctor and one puncture injection doctor in the CT room to complete the treatment operation, which gets rid of the reliance on thoracoscopic equipment and general anesthesia, greatly saving medical resources, and the whole treatment costs only about 4,000 yuan, and the treatment can be completed without hospitalization.
C. The same effect of thoracoscopic surgery can be achieved. Although the thoracic sympathetic nerve is not cut, the activity of the thoracic sympathetic nerve is blocked, and the same treatment effect as that of thoracoscopic surgery can be achieved.
D. The structural integrity of the thoracic sympathetic nerve is still intact, creating the conditions for later recovery of nerve function. Once the nerve is severed, the possibility of recanalization is slim. In other words, if severe compensatory hyperhidrosis occurs after thoracoscopic surgery, the doctor may be helpless; whereas thoracic sympathetic block therapy preserves the structural integrity of the nerve, only blocking its activity, in case of severe compensatory hyperhidrosis, the nerve still has the possibility of repair. Once the nerve is repaired, the problem of compensatory hyperhidrosis will be solved.
E. The blocking operation can be repeated. Thoracoscopic thoracic sympathetic neurectomy needs to be operated through the pleural cavity, and postoperative pleural adhesions are inevitable. If the result is poor or recurrence, it is basically impossible to perform thoracoscopic surgery again. However, nerve block can be repeatedly performed, and even if there is a recurrence of hand sweating, another block treatment can be easily performed.
Shortcomings of CT-guided thoracic sympathetic block for hand sweating.
A. Operation under non-explicit vision. Although it is CT-guided, it still relies on the anatomical positioning of the imaging, rather than operating in the “clear view” like TV thoracoscopic surgery, so the accuracy is not as good as thoracoscopy.
B. The failure rate is higher than that of thoracoscopic surgery, because CT-guided thoracic sympathetic block relies on the injection of a small amount of anhydrous alcohol to block the function of the nerve for a long time, but the injected alcohol has certain mobility, and the flow of alcohol has randomness, if it is not accurately distributed in the location of the thoracic sympathetic nerve chain, the effect of the nerve block may not be satisfactory, that is, this method may have a higher failure rate than thoracoscopic surgery.
C. There is a possibility of hand sweat recurrence. Although anhydrous alcohol can have a blocking effect on the function of the thoracic sympathetic nerve for up to several years, the structural integrity of the thoracic sympathetic nerve is still present, and there is a theoretical possibility of nerve recanalization and recurrence of hand sweating.
D. There may also be transient compensatory hyperhidrosis. If the injected anhydrous alcohol completely blocks the conduction function of the thoracic sympathetic nerve, theoretically there will also be compensatory hyperhidrosis. The good thing is that the sympathetic nerve structure is not completely destroyed and the compensatory hyperhidrosis will disappear on its own with the slow repair of the nerve function.
E. Emerging technology, yet to be perfected, CT-guided thoracic sympathetic nerve block for hand sweating is a newly developed technology, which needs to be observed in a large sample of clinical application studies, so that it can build on its strengths and avoid its weaknesses, and eventually become a new benchmark that can replace thoracoscopic surgery.
13.Does thoracic sympathetic block have any risk in treating hand sweating? What are the precautions?
Although thoracic sympathetic block is not as risky as thoracoscopic surgery, there is theoretically a possibility of pneumothorax, hemorrhage and other puncture complications, as well as the possibility of Horner’s syndrome due to the flow and permeability of the drug solution.
The above complications can be prevented in clinical operation: accurate preoperative positioning of the T3-4 intervertebral space is an effective guarantee of good results; prudent operation under CT guidance and needle entry immediately above the 4th costal margin can avoid intercostal arteries and intercostal nerves, which can prevent puncture injury to the intercostal vessels and bleeding to the greatest extent; slow needle entry and timely correction of needle entry direction and depth under CT guidance can effectively prevent puncture into the In case of puncture complications, they can be detected and treated by intraoperative CT in time. The prevention of Horner’s syndrome can be achieved by the following measures.
① CT localization images are given before and after puncture to ensure that the puncture needle position is at the outer inferior border of the T3 vertebral body. If the needle position is too high, e.g., the tip of the needle reaches the T2 or T1 vertebrae, the drug may penetrate the stellate ganglion more easily;
②The contrast agent iohexol is mixed into the injected fluid, and the flow distribution and diffusion of the injected fluid can be tracked by CT scan and 3D reconstruction. As long as the volume of the injected solution is controlled so that it does not cross the superior border of the 2nd rib joint, no Horner’s syndrome occurs, because anatomical studies have shown that the sympathetic nerve innervating the eye enters the stellate ganglion at a point 5.2±1.6 mm above the superior border of the 2nd rib.
(iii) A test with local anesthetic was performed before the injection of anhydrous alcohol. This can not only clarify the efficacy (whether the palm of the hand from wet cold to dry warm), and can predict whether there will be Horner’s syndrome, once the local anesthetic test that Horner’s syndrome, as long as no longer injected anhydrous alcohol can be quickly recovered.
14.Does thoracic sympathetic block require hospitalization to treat hand sweating? How much does it cost?
Because “CT-guided percutaneous thoracic sympathetic block” only requires two thin needles to be inserted from behind the patient’s back under the guidance of CT, the trauma to the patient is extremely small and the patient can stand and walk immediately after the treatment, so this treatment does not require hospitalization. However, since this technology is not widely used in clinical practice and careful observation of the patient’s response to treatment is still needed, we recommend that patients be hospitalized for 2-3 days (1-2 days for examination before treatment and half a day to 1 day for observation after treatment). If there are no comorbidities, the total hospitalization cost for this treatment is around 9,000 RMB.
15.How to consult and contact to receive treatment?
”CT-guided percutaneous thoracic sympathetic nerve block for hand sweating” is currently only carried out at Jiaxing First Hospital in Zhejiang Province, so please contact the hand sweating clinic at Jiaxing First Hospital for details.
Thoracic sympathetic block is a very practical clinical technique that can be used for the treatment of hand sweating as well as the following diseases.
intractable angina pectoris
cancerous chest pain
postherpetic neuralgia of the upper body
thoracic outlet syndrome
Ischemic diseases of the upper extremities (e.g. Raynaud’s disease)
Axillary odor (fox odor)
Cephalic sweating disorder
compensatory hyperhidrosis
Erythromelalgia.