反射性出汗(或稱代償性出汗)的機轉
而過去做傳統胸交感神經切除術(ETS)時是以止斷T2為主或T2+T3，因阻斷位置靠近T1，造成荷納氏症狀的機率也較高。
(2)當做T3(第三胸交感神經)止斷手術時，因中斷較T2少的回饋訊息，因此輸出正回饋訊息較弱，反射性出汗較T2不嚴重。
(3)當做T4(第四胸交感神經)止斷手術時，大部分的輸入負回饋訊息被保留，因此反射性出汗最少或不顯著，但統計上手掌汗量減少效果較T3少，即手掌剩餘汗量較T3多(註１)。
(4)接下來，阻斷T2、T3或T4 胸交感神經節後，代償性出汗發生率比較表(表1)：
註１參考自 Objective evaluation of patients with palmar hyperhidrosis submitted to two levels of sympathectomy: T3 and T4 , Augusto Ishy,*, Jose Ribas Milanez de Camposa, Nelson Wolosker', Paulo Kauffmanb, Miguel Lia Teddes, Camila Ribeiro Chiavonis, Fabio Biscegli Jatenea, Interactive CardioVascular and Thoracic Surgery 12 (2011) 545-549
交感神經切除手術 (發表年代, 地區, 作者)
|
代償性出汗(%)
|
第二胸 ( T2) (1992, 臺灣, 高明見教授)
|
30-70%
|
第三胸 ( T3) (2003, 澳地利,Neumayer教授)
|
17-25%
|
第四胸 ( T4) (2004, 澳地利,Neumayer教授)
|
3-8%
|
(5)最後，T3或T4 胸交感神經節阻斷手術後，代償性出汗依程度區分(表2)：
代償性出汗(亞洲人)
|
第三胸 (T3) (%)
|
第四胸 ( T4) (%)
|
(1) 不顯著或輕度
|
80.7 (76.9-85.5%)
|
94.8 (92.9-97.1%)
|
(2) 中等
|
19.3 (14.5-23.1%)
|
5.2 (2.9-7.1%)
|
(3) 嚴重
|
0
|
0
|
根據統計156位利用立體定位法燒灼T3或T4患者，代償性出汗依程度結果請見此
圖 參考自The importance of classification in sympathetic surgery and a proposed mechanism for compensatory hyperhidrosis: experience with 464 cases, S.-H. Chou, E.-L. Kao, C.-C. Lin, Y.-T. Chang, M.-F. Huang, 2006
表１參考自T4. SYMPATHECTOMY FOR PALMAR HYPERHIDROSIS: AN EFFECTIVE APPROACH THAT SIMULTANEOUSLY MINIMIZES COMPENSATORY HyPERHIDROSIS
Shah-Hua Chou, Eing-Long Kao, Hsien-Pin Li, Chien-Chih Lin, and Meei-Feng Huang Division of Thoracic Surgery, Department of Surgery, College of Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.(2005) References 4,8,9,13,14
表２參考自
Surgical treatment of primary palmar hyperhidrosis: a prospective randomized study
comparing T3 and T4 sympathicotomy. Liu Y, Yang J, Liu J, Yang F, Jiang G, Li J, Huang Y, Wang J.(2009)
T3/T4 thoracic sympathictomy and compensatory sweating in treatment of palmar hyperhidrosis GeJie, TAN Jia-ju, YE Guo-lin, GU Wei-quan, WANG Jun, LIU Yan-guo, for Chinese Re Hyperhidrosis investigators (2007)
The importance of classification in sympathetic surgery and a proposed mechanism for compensatory hyperhidrosis: experience with 464.cases. Chou SH, Kao EL, Lin CC, Chang YT, Huang ME. Department of Surgery, Faculty of Medical School, College of Medicine, Kaohsiung Medical. University, 100 Shih Chuan 1st Road, Kaohsiung, 80708, Laiwan.(2006)
＊＊因療程效果與個人差異有所不同，需要預約門診由醫師親自診斷後說明。
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