治療過盛／剩：初探胸部交感神經切除術的在地歷史

Treating Excess: A Preliminary Approach to the Local History of Thoracic Sympathectomy

本文討論一項外科術式——胸部交感神經切除術――的演變，並由此討論手汗症作為其治療對象的意涵。以往胸部交感神經切除術被認為是手汗症與若干多汗症的最有效治療，在臺灣有相當多人接受過這項手術。近年來，逐漸有部分患者抱怨這項手術的諸多後遺症，包括代償性出汗。這些患者經過網路集結與實體抗議，改變了衛生單位對於這項術式的管理方式。如今，這個術式已經不常實施，但自居為「手術受害者」的那些患者依然承受身體的受苦。近年的神經重建手術，則又為這個術式的歷史增添了一個方向未明的後話。本文的起心動念在於：我們可以怎麼書寫並看待這段外科術式的歷史？藉著技術的社會形塑的概念，本文描繪了胸部交感神經切除術在地發展的不同分期。探討這項術式的興衰歷程與其社會與技術條件，由此引伸出對於過盛／剩（excess）的反思。本文希望能夠以這個案例提出科技與社會研究的外科術式敘事，也提醒醫療創新的治理與功能性手術的溝通事宜需要注意的事項。

This article explores how thoracic sympathectomy, a treatment for palmar hyperhidrosis, was challenged by disgruntled patients. Thoracic sympathectomy had been regarded as an effective treatment for certain forms of excessive sweating, with many patients undergoing this surgery in Taiwan. In recent years, however, a growing number of patients have expressed dissatisfaction in reaction to their experience of various postoperative sequelae, including compensatory sweating. These patients have organized online and held in-person protests, prompting a shift in health authorities’regulation of this procedure. Consequently, the surgery has become far less common, while its“surgical victims”continue to endure physical suffering. Recent developments in nerve reconstruction surgery have added even more uncertainty to the history of this procedure. This article probes how we can write about and understand the history of this surgical procedure. Employing the concept of the social shaping of technology, this article examines the successive stages in the rise and decline of this procedure in relation to its social and technical conditions, culminating in reflections on the notion of excess. This case study aims to contribute to the narratives surrounding this surgical procedure, thus highlighting critical considerations for governance in medical innovation and the communication surrounding functional surgeries.