Simpatectomia dorsal bilateral en el tratamiento de la hiperhidrosis esencial: efectos sobre la función cardiopulmonar

Abstract

Background: Essential hyperhidrosis is characterized by an overactivity of the sympathetic fibres passing through the upper dorsal ganglia T2-T3 and the treatment of choice is video-assisted thoracoscopy sympathectomy. It is a safe treatment but alterations in cardiopulmonary function after treatment have been reported, related to an overactivity of the autonomic nervous system in these patients. Study objective: To evaluate cardiopulmonary function impairment after sympathectomy in patients with essential hyperhidrosis, before, at three months and three years after surgery. . Design and setting: Prospective controlled trial at a Pulmonary Function Unit of an university hospital. Patients: Twenty patients (M: 2; F: 18) with essential hyperhidrosis. At three years, eighteen patients (M: 3; F: 15) of twenty studied previously were revisited. Measurements and results: Pulmonary function tests-including spirometry and thoracic gas volume, bronchial challenge test with methacholine and maximal exercise test-were performed before and three months after T2-T3 sympathectomy. At three years we repeated the same test with an exception, maximal exercise test and we compare the results with initial values. Video-assisted sympathectomy was performed using a one-stage bilateral procedure with electrocoagulation of T2-T3 ganglia. Pulmonary function values (spirometrics and volumes) were not statistically different in the two groups. The maximal mid-expiratory flow (MMEF) was the only variable that shows significant changes from 101%(26) to 92%(27); p 0. 05. Ten patients had positive bronchial challenge tests that remained positive three months after surgery and two patients whose challenge tests were negative before surgery became positive after sympathectomy. Significant reductions in maximal heart rate and oxygen and CO2 uptakes were observed during the maximal exercise test. There was a significant statistical increment in initial forced expiratory volume (FVC) at three years, changing from 96 ± 10% to 101 ± 11%(p= 0. 008). The maximal mid-expiratory flow (MMEF) shows a significant decrease at three years, changing from 3,8 ± 0,9 L/s to 3,5 ± 0,9 L/s (p= 0. 01). There were no changes in bronchial challenge tests and NO determination at three years. Conclusions: Video-assisted thoracoscopic is a safe treatment and the observed modifications in cardiopulmonary function only suggest a minimal small airway alterations in, presence of positive bronchial hyperresponsiveness and mild sympathetic blockade in heart rate that remained at three years after surgery. The clinical importance of these findings is not significant.

Date of Award	14 Mar 2012
Original language	Spanish
Supervisor	Pere Casan Clara (Director)