Pathogenesis and treatment progress of palmar hyperhidrosis

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1, hand sweat disease is how to return a responsibility?2, hand sweat disease clinical manifestations?In 3, hand sweat disease on people wit

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1, hand sweat disease is how to return a responsibility?

2, hand sweat disease clinical manifestations?

In 3, hand sweat disease on people with no harm?

4. What is the diagnosis process of palmar hyperhidrosis?

5, hand sweat disease have those treatment?

6, how to treat palmar hyperhidrosis?

7, what are the advantages and disadvantages of video-assisted thoracoscopic surgery?

8, what is the compensatory hyperhidrosis?

9, why do you want to develop new techniques for treatment of hyperhidrosis?

10, what is the principle of thoracic sympathetic block in the treatment of palmar hyperhidrosis?

11, thoracic sympathetic block treatment of palmar hyperhidrosis specific operation?

12. What are the advantages and disadvantages of thoracic sympathetic block in the treatment of palmar hyperhidrosis?

13, thoracic sympathetic block treatment of hand hyperhidrosis risk? What precautions?

14, thoracic sympathetic block treatment of hand hyperhidrosis need to be hospitalized? How much does it cost?

15, how to consult and contact treatment?

1, hand sweat disease is how to return a responsibility? To put it simply, hand sweating is a symptom of excessive sweating, accounting for 0.6%~1% of the total population.

Sweating is a normal heat response of the human body, controlled by the sympathetic nervous system in the vegetative nervous system. When the body temperature exceeds the ambient temperature or body temperature set point, in order to prevent the temperature increased further, sympathetic nerve activity, govern the body sweat secretion, through sweat evaporation to remove heat and cooling.

Sweating varies. At the same ambient temperature, some people sweat more, some people sweat less. But when the ambient temperature is not high, normally no need to sweat cooling while still sweating, it is called "hyperhidrosis".

Hyperhidrosis is also divided into two categories: primary and secondary hyperhidrosis hyperhidrosis.

primary

Primary hyperhidrosis refers to no obvious cause of sweat secretion state, is actually the dysfunction of the autonomic nervous system of an excessive secretion of sweat glands. Secondary hyperhidrosis is because the body has some neuroendocrine and other

The disease (such as hyperthyroidism, diabetes, hypoglycemia, poisoning, drug side effects, cardiovascular disease, respiratory failure, carcinoid syndrome, Hodgkin disease) caused by sweating symptoms.

According to the position of sweating, hyperhidrosis can be divided into systemic and local hyperhidrosis hyperhidrosis. Systemic hyperhidrosis as secondary hyperhidrosis, and localized hyperhidrosis, for primary hyperhidrosis.

Hyperhidrosis is actually a primary local hyperhidrosis, known cause is the dominant hands sweat gland secretion function of thoracic sympathetic nerve activity caused by the high.

After the survey of family members of the people with the disorder, it is found that the symptoms are familial and show autosomal dominant inheritance.

2, hand sweat disease clinical manifestations? The main manifestations of primary hyperhidrosis is not affected by outside temperature of bilateral palmar hyperhidrosis, showed only mild hand moist, severe hand can secrete visible sweat, serious will drop along the fingers. Sweating with the palm of the hand is too cold, only a few cases of sweating fingers can keep warm. Part of the patient also combined with sweating feet or head and face, armpit sweating.

A

Sweat and emotional activity is extremely relevant, the spirit of sweating more tense. The occurrence of symptoms is characterized by sudden and intermittent, and the duration of each episode is 5 to 30 minutes, and the number of episodes per day is uncertain

Sweat。 The majority of patients with severe summer symptoms, relatively mild symptoms in winter. The individual patient thought of sweating, hand sweat immediately spewing out, correlation degree and environmental temperature far less and the spiritual activity related degree.

Moreover, hand sweat disease often has the following performance:

A, plantar hyperhidrosis hyperhidrosis: in 40% ~ 45% and plantar hyperhidrosis, and foot sweat more likely to accumulate, even if the frequent replacement of footwear can't timely removal of sweat and odor. Therefore, the most prone to secondary plantar skin lesions, such as dermatitis, tinea pedis, hyperkeratosis of skin exfoliation, skin herpes etc..

B, hand sweat in axillary hyperhidrosis: 25% to 30% patients with axillary hyperhidrosis, easy to sweat soaked clothes, the armpit sweat stain showed a large shape. Because of the hidden parts of the armpit is also easy to cause the skin bacteria or fungal infections, severe skin erosion occurs.

C, facial hyperhidrosis: combined craniofacial hyperhidrosis accounted for 1%~5%. Parts are mostly concentrated in the forehead sweat from flowing down, into the eye frame and neck, need to wipe to keep the face dry, most of the patients with severe facial flushing, purple red, showing an uneasy awkward appearance.

D,

Easy foot frostbite: hand sweat foot sweating is their Humicool, foot temperature only 33 degrees Celsius, no sweat than those of low 2~3 C, thus prone to frostbite in winter. Because the hands and feet are often in sympathetic contraction of the blood vessels, hand and foot

Bluish gray. Brothers often soaked in sweat, often appear "peeling" phenomenon, occasionally sweat herpes (acrohyperhidrosis when syringocystadenoma port plug a eczematoid caused sweat retention in volar skin changes appear).

In conclusion, primary hyperhidrosis symptoms, diagnosis is not difficult, but in the end to a regular hospital, to exclude secondary hyperhidrosis, symptomatic treatment.

In 3, hand sweat disease on people with no harm? Hand hyperhidrosis is only the human body sympathetic nerve relative excitement, no harm to health.

But because of the palms and soles and axillary hyperhidrosis, bring a lot of inconvenience to study, work and life, social activities. For example students exams because of hand sweating easy wet test, the operation of the computer keyboard, engaged in electrical work wet sweat wet easy electric shock and social exchanges due to severe sweating palm to shake hands with others...... , and so on, does bring some trouble to work life.

4. What is the diagnosis process of palmar hyperhidrosis? The diagnosis of hyperhidrosis is relatively easy, Guan Jian is going to the primary and secondary hyperhidrosis hyperhidrosis distinguish.

A, history collection points:

(1) to determine the exact location of hyperhidrosis, local or systemic hyperhidrosis belong to judgment.

(2) the frequency and duration of episodic sweating.

(3) age at onset.

(4) whether there is a family history.

(5) whether with fever, night sweats, weight loss and other systemic symptoms.

(6) whether hyperhidrosis associated with emotional activities.

(7) the impact of social, professional, and daily life.

(8) the exclusion of other secondary hyperhidrosis symptoms.

B, physical examination:

The local primary hyperhidrosis patients, the general can only detect the abnormal sweating and positive signs of secondary skin lesions: such as palm peeling, sweat herpes, chilblain etc..

Note that some beneficial and systemic hyperhidrosis differentiate diagnosis positive signs. Such as weight loss may indicate chronic systemic wasting disease, acromegaly may be associated with diseases of the endocrine system, should further eliminate hyperthyroidism may increase heart rate, elevated blood pressure should be excluded pheochromocytoma.

C, auxiliary examination:

Hyperhidrosis diagnosed before the inspection should also include blood, urine routine examination, blood glucose, T3, and T4 concentration determination. In addition, chest X-ray or chest CT examination can exclude the presence of intrathoracic tuberculosis and other diseases.

If the preparation of surgical treatment should be performed chest CT examination to exclude the disease such as pleural thickening. For suspected systemic disease cases should be related to the examination of the project, such as suspected pheochromocytoma should be urine catecholamine derivatives.

5, hand sweat disease have those treatment? There are six kinds of treatment methods for hand hyperhidrosis.

Lotion for external use:

Lotion is mainly soaking application convergence effect of alum, glutaraldehyde solution of tens of minutes, may have a certain effect in a few days, but will have skin injury of hand, wrinkling, cracking and other lesions phenomenon, and the effect is not lasting.

Oral anticholinergic agent:

Systemic use of anticholinergic drugs Urotropine sympathetic nerve activity inhibited to a certain extent, the sweat is relatively reduced, but the drug is recurrent, dry mouth, fast heartbeat and other complications often occur during the treatment and.

Oral anti anxiety drugs

primary

The onset of hand sweating is often caused by emotional activity, especially when the spirit is nervous, but not after sweating. To this end, sedative and anti anxiety drugs can have a certain therapeutic effect. Commonly used drugs such as diazepam

Agent: diazepam, estazolam tablets, midazolam tablets, think of North, an anti anxiety drug amitriptyline tablets, Prozac, Dai Lixin etc.. But the sedative and anti anxiety drugs often cause listlessness, fatigue weakness, inattention. Take a long time

Drug dependence, and therefore less used in the treatment of palmar hyperhidrosis.

The local injection of botulinum toxin:

Injection of botulinum toxin into the skin of the palm surface can reduce or stop the injection site for 1~3 months. However, this method of severe pain, the need for multiple injections, repeated injections, easy to cause complications such as infection, and the cost of high, each hand injection therapy need to be nearly a thousand dollars, and can only be effective for 1~3 months.

The surgical treatment:

The traditional thoracotomy in thoracic sympathetic chain cutting in the treatment of hyperhidrosis began in 1954, Kux first open thoracotomy T2 blocking successful secretion of sweat, but due to thoracic trauma is huge, difficult to promote (the traditional surgical approach is central to starting from the back, on both sides of the second and third sympathectomy, the operation time, recovery time is longer that risk is big, after about five ~ seven cm wound)

since

1992 video assisted thoracoscopic sympathectomy (ETS, Endoscopic thoracic)

Sympathectomy for the treatment of hand sweat disease, the current operation has become a surgical treatment of palmar hyperhidrosis of the "gold standard": incision in each side of the axilla 1~3 small incision, each about 1~2 cm

The hole in the vats, and then cut off the domination of thoracic sympathetic sweat secretion in the TV monitor, the operation time, recovery time than traditional thoracotomy pain than traditional surgery is short, light, but still need surgery with general anesthesia, fee

With higher (10000 yuan or more). At present, the operation in the country to carry out more, the technology is more mature, there are three hospitals around the VATS can basically carry out.

The minimally invasive treatment of ----CT guided percutaneous puncture of thoracic sympathetic nerve block.

This technique is a new method in the treatment of hyperhidrosis, without surgery, without anesthesia, CT guided fine needle puncture from behind near two to sympathetic nerve, 2ml injection anhydrous alcohol can be cure hyperhidrosis.

A new method of noninvasive treatment can be done almost, walking as usual, and the cost is only 4 thousand yuan, have recovered from Shaanxi, Hubei, Xinjiang and Jiaxing, a local group of patients, is a promising method for.

6, how to treat palmar hyperhidrosis? Although there is no exact mechanism quite clearly the primary hyperhidrosis, but has made clear the thoracic sympathetic overactivity and hyperhidrosis occurred directly related to. The effect of cutting off the thoracic sympathetic nerve chain in the treatment of palmar hyperhidrosis has been clinically proved.

After routine thoracic surgery to cut off the thoracic sympathetic nerve to treat hand hyperhidrosis, video assisted thoracoscopic sympathectomy (ETS) has become a classic procedure for the treatment of palmar hyperhidrosis.

before

General anesthesia was carried out by the anesthesiologist patients with palmar hyperhidrosis, inserted double lumen catheter to ensure double lung ventilation respectively. The first surgeon in the axilla in patients relative concealment open incision 1~3 2cm about the control patients by anesthesiologists

On the side of one lung ventilation, lung surgery is completely collapsed, the chest is completely exposed, by stretching the chest shot the thoracic sympathetic chain video displayed on the TV screen, the operation at the TV screen, from another incision

Electric knife into the arrived for the electrocautery in the thoracic sympathetic chain T2~T4's position, to cut off the sympathetic chain at these positions. Then pull out the lens, hemostasis, anesthesiologists drum lung, placement of closed thoracic drainage, and then use the same

Method of cutting off the sympathetic nerve chain of the contralateral thoracic cavity.

After discontinuation of anesthesia for anesthesiologists, fully awake after extubation, with further recovery can speak, one day you can get out of bed. General three days after surgery can be discharged from hospital, 5~10 days can be removed incision suture.

The sense of thoracic sympathetic nerve chain cut, hand sweat phenomenon disappeared immediately, and can no longer attack life. But some patients will appear compensatory hyperhidrosis, namely hand sweat out, but the chest back and thighs and sweating more than before.

7, what are the advantages and disadvantages of video-assisted thoracoscopic surgery? Advantages of thoracoscopy in the treatment of palmar hyperhidrosis:

A, and compared with conventional thoracotomy, video-assisted thoracoscopic surgery, small incision, significantly reduced trauma, postoperative recovery.

B, VATS produced with camera equipment into the pleural cavity, pleural cavity will be the recording on the edge of the table on the TV screen, with the equivalent of "bright" of thoracic sympathetic nerve electric knife cut, accurate operation, curative effect.

C, surgery in the operation room under general anesthesia, once the bleeding, pneumothorax and other complications, can be carried out at any time to stop bleeding, drainage, etc..

The shortage of thoracoscopy in the treatment of palmar hyperhidrosis:

A, although compared with conventional thoracotomy trauma a lot, but still need a 2~6 incision, postoperative suture incision, postoperative pain is severe, returned to normal at least 5~15 days, the incision may also leave obvious scars.

B, surgery under general anesthesia, the need to insert a double lumen endotracheal tube, single lung ventilation during the operation, the patient has the risk of carbon dioxide accumulation and hypoxia, as well as other anesthesia related risks.

C,

There is a relative contraindication. Thoracoscopic surgery required by pleural cavity operation, if patients with pleurisy or pleural thickening and adhesion, or other pleural cavity disease, thoracoscopic surgery for thoracic sympathetic nerve can not be exposed and had to give up. That is

Such patients can not be completed under thoracoscope surgery. In addition, limited to the double lumen tube type, trachea or meticulous with tracheal stenosis will be double lumen tube intubation difficult to accept thoracoscopic surgery.

D,

The risk of surgery is larger, and the possible complications are more. Complications may include: due to chest bleeding caused by hemothorax, pneumothorax or rupture caused by pulmonary alveolar membrane. Very few patients will have Horner 's

syndrome

(mild ptosis of the eyelid), which affects the appearance but does not affect vision. If this complication is permanent, cosmetic surgery should be performed. Others may be potentially dangerous, as in any surgery, such as anesthesia

Drug allergy, and literature also has the rare cause of chylothorax, vascular damage report.

E,

Postoperative compensatory sweating is a difficult problem in the treatment of palmar hyperhidrosis. After the transection of the thoracic sympathetic nerve, the sympathetic nervous system at the lower end of the trunk has lost the descending inhibition of the high center (brain), resulting in the enhancement of the autonomic activity,

So that the abdomen, chest and back, and a large increase in the amount of sweating, the majority of patients with this complication can endure, there are more than 25% of the patients feel very uncomfortable, and even regret the surgery. Although many patients

Compensatory sweating will gradually decrease with the extension of time, but also bring some new problems to some patients.

F,

Special equipment, large medical resources, high medical costs. This treatment is necessary to have a chest of television units can be carried out, and more than one million yuan in vats, many of the three hospitals do not have this device. When carrying out this operation

Need 5~8 medical staff at the same time to participate in the occupation of a large medical resources, combined with operating expenses, anesthesia costs, hospitalization expenses, thoracoscopic thoracic sympathetic amputation surgery for the treatment of palmar hyperhidrosis costs more than 10000 yuan.

8, what is the compensatory hyperhidrosis?

Compensatory hyperhidrosis refers to the part of body surface area due to disease or surgery caused no sweat, another part of body surface asymmetry sweat secretion hyperfunction condition. Sympathetic nerve injury (including sympathectomy), spinal cord injury, diabetic neuropathy can cause compensatory hyperhidrosis.

At present, compensatory hyperhidrosis after cutting thoracic sympathetic chain is because sympathetic nerve stump following the lost high central (hypothalamus) descending inhibition, sympathetic activity induced by abnormal enhancement.

Specific performance in the original in the palm of the hand, the face of sweat, in the operation to get rid of the body, especially in the back, thighs and other places of sweat will be increased than the original phenomenon. Moreover, once the thoracic sympathectomy was performed, and if there was a significant compensatory sweating after the operation, the sweating could not be restored to the original condition of the operation before surgery.

Therefore, remains a conundrum is compensatory hyperhidrosis thoracoscopic surgery in the treatment of palmar hyperhidrosis. General surgery showed mild to moderate compensatory hyperhidrosis patients were acceptable, but a few severe compensatory hyperhidrosis indeed to the patient's life brings serious trouble.

9, why do you want to develop new techniques for treatment of hyperhidrosis? Although the efficacy of thoracoscopic surgery in the treatment of hyperhidrosis is exact, but it is still a large trauma and complications associated with risk, need to add special equipment, large occupation of medical resources, the high cost of treatment, but also the part of the economic conditions are not good hand sweat have to endure to sweat the inconvenience, can not accept thoracoscopic surgery treatment.

In addition, postoperative compensatory hyperhidrosis is a problem unsolved in thoracoscopic surgery. Because once the thoracic sympathetic nerve was removed from the chest mirror, it would be very difficult to put it together. That is to say, if the compensatory hyperhidrosis after operation, is still unable to solve this problem.

So can we develop a more minimally invasive, more economical and safer treatment technology?

answer

The case is positive. Because of the development of medical technology, minimally invasive treatment means there is no end, that is, what kind of treatment technology, are only better, not the best. Thoracoscopy is a better way to replace traditional thoracotomy

It is the golden standard for the treatment of palmar hyperhidrosis, but there will be a limitation, that is, thoracoscopic surgery in this era is the best way, in the future, of course, there will be a better way to replace it.

CT guided percutaneous puncture of thoracic sympathetic nerve block technique in the treatment of hyperhidrosis more minimally invasive, more economical and can avoid or reduce the occurrence of compensatory hyperhidrosis, is expected to become the new gold standard after thoracoscopic surgery after a treatment of hyperhidrosis".

10, "CT guided percutaneous thoracic sympathetic block" treatment of palmar hyperhidrosis is what principle? god

If you want to work properly, you need to have the integrity of the structure and function. Once the nerve structure is destroyed, it will lose its basic function; similarly, if the drug is used to block the conduction of the nerve, although its structure is complete,

Will lose function. The simplest example is the nerve block anesthesia (such as the waist anesthesia or arm from nerve block), that is, local anesthetics in the subarachnoid space or near the brachial plexus, so that the drug temporarily block the nerve conduction

Function, so the lower body or upper limb paralysis, like paraplegia. But the local time is very short, the longest ten hours on the failure, nerve function restored.

The cutting and thoracoscopic sympathetic nerve surgery, CT guided percutaneous thoracic sympathetic nerve block technique is not broken, but the function of nerve block. But short acting local anesthetics into ethanol can long-term effective.

In other words, the thoracic sympathetic block technique is to retain the integrity of the thoracic sympathetic nervous system, by blocking the nerve function to achieve the purpose of treatment of hand sweat. That is, to reduce the activity of sympathetic nerves by injecting alcohol into the thoracic sympathetic nerve rather than cutting it off.

11, thoracic sympathetic block treatment of palmar hyperhidrosis specific operation? The diagnosis of primary hyperhidrosis, check the platelet and clotting time, without coagulation dysfunction, to obtain informed consent of patients after doing iodine allergy test, negative intravenous trocar into the CT room.

Patients prone to CT, in the 3 and 4 thoracic vertebral body (T3, 4) is placed on the back skin of the corresponding positioning grid, CT like (Fig. 1) accurate positioning of T3-4 intervertebral space, and to the center of the thick 3mm scan of the upper and lower two vertebral bodies, find out and lock fourth rib rib head on the bare level (without ribs, intervertebral foramen, vertebral facet occlusion, can be used for CT layer puncture

The surface, as shown in Figure 2) as the puncture needle puncture path design level, at the level of fourth targets: the costovertebral joints on the outer edge of the vertebral body of T3 lower margin (corresponding to the fourth rib head above the skin on both sides of the needle selected the best

In CT, the tool ruler measured needle point and target distance (depth of needle), the angle of the needle, the needle distance from the midline, and the bed frame level record CT display angle and relative distance. Locate the red line,

According to the distance measured from the center line, a marking pen is used to mark the puncture points on both sides of the positioning red line. The selected puncture point after local anesthesia according to the determined angle and depth in CT guided by 7 RF needle puncture needle in the process

Adjust the CT scan again and again until the tip is close to the upper edge of the fourth rib joint to reach the target (Figure 3, figure 4). Use CT to locate the needle as it is located

The outer edge of T3 vertebral T3-4 intervertebral space above (Figure 5). Dry the patient's hand, measure and record the temperature of the palm

DEG C). Catheterwhen no blood, liquid and gas, each point injection of 1% lidocaine 3ml (contrast agent containing 30% Iohexol Injection 0.3ml), CT scan showed the injection liquid covering the T3 vertebral body and 4 ribs on both sides of the outer margin after

The spine head outside the ditch, the liquid on the parietal pleura margin just reached third costovertebral joint level abroad (Figure 6, Figure 7, figure 8, figure 9). Observation of 25min, patients with no numbness and activity of the lower limbs, both without

Horner' s syndrome, both hands by wet dry warm (

DEG C). Into the left and right are anhydrous alcohol each 2.5ml (each containing 1ml 0.9ml, Iohexol Injection 0.1ml 30% ethanol), the needle again after CT, confirmation of alcohol in the parietal pleura wrapped

Third, 4, 4 and T3 rib head lateral margin of vertebral body, liquid T2 edge of vertebral body (Figure 10, figure 11). CT observation of lung window, no hemothorax, pneumothorax.

12. What are the advantages and disadvantages of thoracic sympathetic block in the treatment of palmar hyperhidrosis? The advantage of thoracic sympathetic block in the treatment of palmar hyperhidrosis:

A, more minimally invasive. The technology as long as under the guidance of CT from the back of the two needles into the chest near the sympathetic chain can be medicine, no surgery, no anesthesia, no incision, no scar, after treatment, the patient can get up and leave.

B, more economical. The only 1 imaging doctor and a puncture injection in the treatment of operation in the CT room to get rid of the dependence on thoracoscopic equipment and general anesthesia, save medical resources, the treatment costs only 4 thousand yuan, also can complete the treatment without hospitalization.

C, can achieve the same effect of thoracoscopic surgery. Although it did not cut off the thoracic sympathetic nerve, it blocked the activity of the thoracic sympathetic nerve, and it could achieve the same therapeutic effect as thoracoscopic surgery.

Integrity is still D, thoracic sympathetic nerve, for days after the recovery of nerve function to create the conditions. Once the nerve is cut off, the possibility of recanalization is small. That is to say, after thoracoscopic surgery if severe compensatory hyperhidrosis, and thoracic sympathetic doctor may be at a loss what to do; block therapy preserved the integrity of neural structures, but its activity is blocked, in case of severe compensatory hyperhidrosis, and nerve repair is possible. Once the neural repair, compensatory sweating problems will be smoothly done or easily solved.

E, can be repeated block operation. Thoracoscopic thoracic sympathectomy is required to operate through the pleural cavity, pleural adhesions after surgery is inevitable, if the effect is not good or recurrence, once again is not possible to perform thoracoscopic surgery. However, nerve block can be repeated, even if the recurrence of hand sweat, can also be easily blocked again.

CT guided thoracic sympathetic blockade in the treatment of hyperhidrosis:

A, non visual operation. Although CT is the positioning, but still rely on imaging anatomical location, rather than the VATS as "photopic", thus the accuracy of inferior thoracoscopy.

B, failure rate higher than thoracoscopic surgery. CT guided by thoracic sympathetic block is a small amount of anhydrous alcohol injection on nerve block for a long time, but the alcohol injection has certain liquidity, and alcohol distribution is random, if not accurate flow in thoracic sympathetic nerve block on the chain position, the effect may not be satisfactory, this method may there are higher than the failure rate of thoracoscopic surgery.

C, hand sweat recurrence may. Although the effect of alcohol on the function of the thoracic sympathetic nerve can be up to several years, but the structural integrity of the thoracic sympathetic nerve is still in theory, there is the possibility of recurrent nerve, hand sweat recurrence.

D, there may be a compensatory sweating phenomenon. If injecting anhydrous alcohol the conduction function of thoracic sympathetic nerve was completely blocked, the theory will also have the occurrence of compensatory sweating phenomenon. Fortunately, the sympathetic nerve structure has not been completely destroyed, with the slow repair of nerve function, compensatory hyperhidrosis will disappear.

E, emerging technologies, yet to be improved. CT guide in treatment of thoracic sympathetic nerve block hyperhidrosis for the newly developed technology, still need a large clinical sample application of observation, in order to avoid weaknesses, and ultimately become the new benchmark can replace video-assisted thoracoscopic surgery.

13, thoracic sympathetic block treatment of hand hyperhidrosis risk? What precautions? Chest sympathetic blockade is not like the risk of thoracoscopic surgery is so big, but the theory also has the occurrence of pneumothorax, bleeding and other complications of puncture may, together with some liquid flow, permeability, there was Horner' the possibility of s syndrome.

Yes

The complications in the clinical operation, also can prevent: the accurate preoperative localization of T3-4 intervertebral space is the effective guarantee to achieve good results; CT under the guidance of prudent operation, close to fourth costal margin above the needle can avoid the MA

Vein and intercostal nerve, the maximum extent to prevent puncture injury of intercostal vascular hemorrhage; slow needle and CT under the guidance of correct direction and depth of needle can effectively prevent the penetration of spinal injury to the spinal cord or punctured parietal pleura triggered gas

Chest; in case of puncture complications, can also be found in the timely detection of intraoperative CT. For Horner', the prevention of s syndrome can be achieved by the following measures: first, before and after the puncture to the CT image to ensure that the puncture

Needle position in the lower edge of the T3 vertebral body. If the puncture needle position is too high, such as the tip of the needle up to T2 or T1 vertebral body, the liquid medicine may be easier to block the stellate ganglion infiltration; to the injection of liquid medicine into the contrast agent iodine alcohol, can be detected by CT

Scanning, 3D reconstruction tracking injection liquid spread diffusion. As long as the control of the amount of liquid injection, so that it does not cross the upper edge of the second rib joints, when no Horner' s syndrome occurs, because the anatomical study shows,

The location of the sympathetic nerve into the stellate ganglion was higher than that of the second rib

5.2 + 1.6mm. The injection of anhydrous alcohol before local anesthetics do test. This will not only clear the effect (whether by wet and dry warm palm), and can predict whether there will be a Horner' s syndrome

Once the local anesthetics test is Horner' s syndrome, as long as no longer can be quickly recovered anhydrous alcohol injection.

14, thoracic sympathetic block treatment of hand hyperhidrosis need to be hospitalized? How much does it cost? because

"CT guided percutaneous thoracic sympathetic nerve block" simply tie two fine needle from the back of patients under the guidance of CT, the trauma of the patient is extremely small, after treatment, the patient can immediately stand up and walk, so the treatment without

Hospitalization。 But because of the technology in clinical application is not wide enough, the patient's response to treatment still need to observe carefully the summary, so we suggest that patients receiving the treatment or hospitalization for good, general hospital 2~3

Days (1~2 days before treatment, after treatment for half a day ~1). If there is no complication, the total cost of hospitalization in the treatment of about 9000 yuan.

15, how to consult and contact treatment? CT guided percutaneous thoracic sympathetic nerve block in the treatment of palmar hyperhidrosis, the First Affiliated Hospital of Zhejiang University in the development of specific matters related to the First Affiliated Hospital of Zhejiang University and pain clinic. Telephone contact with pain ward, Tel: 0571-87236858

16, CT guided thoracic sympathetic block can also treat what disease? Thoracic sympathetic block is a very practical clinical technique. It can be used in the treatment of the following diseases except for the treatment of palmar hyperhidrosis:

L intractable angina pectoris

L cancer chest pain

L upper body postherpetic neuralgia

L thoracic outlet syndrome

L upper limb ischemic disease (such as Raynaud's disease)

The L (body odor)

Head sweating

compensatory hyperhidrosis

Red fleck acrodynia

 

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