影響上肢多汗症患者接受交感神經手術之相關因素及術後五年之生活品質差異

Changes in Quality of Life at Five-year Follow-up and Factors Associated with Receiving a Thoracoscopic Sympathectomy for Hyperhidrosis

研究背景及目的：多汗症是指身體某部位的排汗量較一般人為多，其可發生在頭、頸部、腋下、手掌、軀幹或是足底，其中以手掌及腋下部位的多汗症最使人可惱。目前全世界皆公認經腋下進入胸腔使用內視鏡上段交感神經截／阻斷術是最有效治療多汗症的手術方法，但是手術後部分患者會產生不良反應──代償性出汗。台灣執行內視鏡交感神經治療多汗症的手術案例高居全世界之冠，目前卻仍缺乏多汗症患者術後生活品質評估之研究報告。另外，臨床上發現接受手術的患者有急遽減少的趨勢，我們也在此研究一併探討其原因。研究方法：本研究為一橫斷性研究。以中部某醫學中心共528例，因多汗症至門診就醫的患者為研究對象。同時進行電話訪問和郵寄。問卷內容含翻譯後國外版多汗症患者生活品質評估表，及患者個人基本資料。將問卷回收後以Microsoft Office Excel 加以整理、定義並儲存，而後以統計分析軟體SPSS（statistical package for the social sciences）進行資料分析，最後以邏輯斯迴歸分析影響多汗症患者是否接受交感神經手術的重要影響因素。研究結果：對生活品質而言，接受交感神經手術之多汗症患者對於症狀影響生活品質的平均值較高。在考慮是否接受交感神經手術的因素比較，以術前症狀對生活品質的影響、接受手術的財務負擔、家人是否支持手術、是否曾接受其他非手術治療、就醫時是否有工作、醫師是否鼓勵接受手術、以及是否考慮術後代償性出汗的嚴重度等七項為影響因素。而在代償性出汗方面，有高達90%的患者出現代償性出汗症狀，且嚴重代償性出汗高達72%。結論：台灣執行內視鏡交感神經治療多汗症的手術成果並不如國外的高滿意度。雖然交感神經手術對於多汗症患者有提昇生活品質的實質幫助。想要提高多汗症患者接受交感神經手術的意願，必須從醫師的態度及詳細的解釋、重新定位交感神經的手術位置、減少術後代償性出汗的機會和嚴重度著眼才行。

Objective: Our aim was to explore long-term changes in the quality of life and the factors that influenced patients with upper limb hyperhidrosis to undergo thoracoscopic sympathectomy surgery to reduce sweating. Methods: A cross-sectional study was conducted with a structured questionnaire in order to determine the perceived quality of life and decision about surgery. A total of 528 patients with hyperhidrosis were recruited from a medical center in Taiwan. The impact of hyperhidrosis on quality of life with or without undergoing thoracoscopic sympathectomy surgery was evaluated. The factors influencing the patient's decision to receive surgery were examined with multivariate logistic regression analysis. Results: The impact of the symptom of hyperhidrosis on patients’ quality of life was 7.21 points (1-10 points) on average for patients who chose surgery and 4.89 points for patients who did not. The impact of hyperhidrosis on quality of life was reduced from 7.21 to 5.22 for post-operative patients 5 years after the surgery. Approximately 90% of these patients had symptoms of compensatory sweating after surgery and 72% of these had severe symptoms. Factors significantly influencing patients’ decisions to have a surgery included age (OR:1.78-5.06), the effect of pre-operative symptoms on the quality of life (OR:1.24; 95%CI:1.11-1.39), the financial burden of surgery (OR:0.80; 95%CI:0.72-0.89), family support (OR:1.44; 95%CI:1.31-1.58), effectiveness of nonsurgical treatments (OR:0.39; 95%CI:0.20-0.75), work status at the time of seeking medical help (OR:2.14; 95%C I:1.10-4.18), physician's opinion (OR:4.92; 95%CI:2.34-10.34), and concerns about postoperative compensatory sweating (OR:0.16; 95%CI:0.09-0.29). Conclusions: Patients with hyperhidrosis who underwent surgical therapy had improved quality of life, although compensatory sweating could be severe and was a major concern. Physician attitude played an important role in patients’ decisions about surgical therapy.