Simpatectomia torácica para o tratamento da hiperidrose axilar primária: revisão sistemática e metanálise proporcional
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Data
2020-02-18
Autores
Felisberto Junior, Gilmar [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A hiperidrose primária é uma condição na qual há uma produção excessiva de suor, com impacto negativo na qualidade de vida dos indivíduos acometidos. Objetivo: Avaliar a efetividade e segurança da simpatectomia torácica para hiperidrose axilar primaria, e determinar qual nível da ressecção ganglionar oferece o melhor resultado. Método: Foi realizada uma revisão sistemática e metanálise proporcional de estudos experimentais ou observacionais que avaliaram o tratamento cirúrgico da hiperidrose primária axilar através da simpatectomia torácica realizada por videotoracoscopia. Os desfechos avaliados foram satisfação, controle dos sintomas, sudorese compensatória e complicações. Também foi feita uma análise de subgrupo comparando secções do tronco simpático em níveis altos e baixos. Resultados: Foram selecionados 13 estudos, que somaram 1463 pacientes. Houve predomínio do sexo feminino e a idade média foi de 28 anos. A taxa de satisfação geral foi de 92% (IC 95% = 88% a 95%, I2= 47,5%), a taxa de controle dos sintomas foi de 96% (IC 95% = 93% a 99%, I2=48,2%) e a presença de sudorese compensatória não pode ser avaliada devido a elevada heterogeneidade entre os estudos. As complicações relatadas foram raras e não houve nenhum caso grave. Conclusão: Esta revisão mostrou que a simpatectomia torácica por videotoracoscopia apresenta-se como uma alternativa viável e segura para o tratamento definitivo da hiperidrose axilar primária, com boas taxas de satisfação e controle dos sintomas e baixas taxas de complicações.
Introduction: The primary hyperhidrosis is a condition in which there is an excessive sweat production, with a negative impact on the quality of live for those who has it. Objective: Evaluate the effectiveness and security of the thoracic sympathectomy to axillary primary hyperhidrosis and determine which level of the ganglionar resection show the better result. Method: a systematic review and proportional meta-analysis of experimental or observational studies that evaluated the surgical treatment of axillary primary hyperhidrosis through thoracic sympathectomy by videothoracoscopy. The outcomes were satisfaction,symptoms controls, compensatory sweat and complications. A subgroup analysis was performed comparing sympathetic trunk sections at high and low levels. Results: Thirteen studies were selected, which evaluated 1463 patients. There was a predominance of females and the average age was 28 years. Satisfaction was 92% (CI 95% = 88% to 95%, I2= 47,5%), symptom control was 96% (CI 95% = 93% to 99%, I2=48,2%) and the presence of compensatory sweating could not be assessed due to the high heterogeneity between studies. Related complications were rare and there were no serious cases. Conclusions: This review showed that the thoracic sympathectomy by videothoracoscopy presents as a safe and viable way for the definitive treatment of the axillary primary hyperhydrosis, with good rates of satisfaction and symptoms controls and lower rates of complications.
Introduction: The primary hyperhidrosis is a condition in which there is an excessive sweat production, with a negative impact on the quality of live for those who has it. Objective: Evaluate the effectiveness and security of the thoracic sympathectomy to axillary primary hyperhidrosis and determine which level of the ganglionar resection show the better result. Method: a systematic review and proportional meta-analysis of experimental or observational studies that evaluated the surgical treatment of axillary primary hyperhidrosis through thoracic sympathectomy by videothoracoscopy. The outcomes were satisfaction,symptoms controls, compensatory sweat and complications. A subgroup analysis was performed comparing sympathetic trunk sections at high and low levels. Results: Thirteen studies were selected, which evaluated 1463 patients. There was a predominance of females and the average age was 28 years. Satisfaction was 92% (CI 95% = 88% to 95%, I2= 47,5%), symptom control was 96% (CI 95% = 93% to 99%, I2=48,2%) and the presence of compensatory sweating could not be assessed due to the high heterogeneity between studies. Related complications were rare and there were no serious cases. Conclusions: This review showed that the thoracic sympathectomy by videothoracoscopy presents as a safe and viable way for the definitive treatment of the axillary primary hyperhydrosis, with good rates of satisfaction and symptoms controls and lower rates of complications.
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Palavras-chave
Hiperidrose, Axila, Simpatectomia, Cirurgia torácica vídeo-assistida, Revisão sistemática, Hyperhydrosis, Axilla, Sympathectomy, Thoracic surgery, Video-assisted, Sistematic review