The effect of thoracosopic thoracic sympathetomy on pulmonary function and bronchial hyperresponsiveness.
BACKGROUND
Endoscopic thoracic sympathectic denervation (ESD) is a procedure used in primary hyperhidrosis and upper extremity ischemia. Bronchial tone is affected by the sympathetic and parasympathetic nervous systems and bronchial asthma is associated with an imbalance between them. The aim of this study was to evaluate the effects of ESD on pulmonary function and bronchial hyperresponsiveness (BHR).


METHODS
Fifty-eight patients with primary hyperhidrosis (n = 54) or upper limb ischemia (n = 4) were included. Spirometry and bronchial provocation test with methacholine was performed before and 4 weeks after ESD.


RESULTS
Forced expiratory volume in 1 second (FEV(1)) and forced vital capacity (FVC) were significantly decreased early after ESD (from 4.67 +/- 0.84 L and 4.36 +/- 0.85 L to 4.12 +/- 0.78 L and 3.84 +/- 0.82 L, respectively), although no patient complained of an aggravation of respiratory symptoms. Twelve patients (21%) had a positive response to methacholine provocation preoperatively, and all remained positive post surgery. The provocative concentration of methacholine, which brought about a 20% decrease in the FEV(1) in the patients, was not significantly changed after surgery (from 5.1 +/- 4.3 to 4.6 +/- 4.6). Of 46 patients who had a negative result for methacholine challenge preoperatively, 12 (26%) became positive after surgery. In terms of the level of sympathectomy, T3 sympathectomy significantly increased the ratio of patients exhibiting a positive response to methacholine (from 19% to 34%, respectively) (p < 0.005).


CONCLUSIONS
Thoracic sympathectomy can adversely affect lung function early after surgery, although the clinical significance is uncertain. It may also exert an influence on the development of bronchial hyperresponsiveness, especially when performed at the T3 level.
Kim
Young Du
YD
Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea, Seoul, South Korea.
Lee
Sang Haak
SH
Lee
Sook Young
SY
Seo
Jong Hee
JH
Kim
Jae Jun
JJ
Sa
Young Jo
YJ
Park
Chan Beom
CB
Kim
Chi Kyeong
CK
Moon
Seok Whan
SW
Yim
Hyeon Woo
HW
D000293:Adolescent; D000328:Adult; D000368:Aged; D016535:Bronchial Hyperreactivity / Q000139:chemically induced* / Q000503:physiopathology; D001985:Bronchial Provocation Tests; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery; D007511:Ischemia / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D013562:Sympathectomy / Q000009:adverse effects* / Q000379:methods; D013900:Thoracic Nerves / Q000601:surgery*; D034941:Upper Extremity / Q000098:blood supply / Q000294:innervation; D055815:Young Adult