Sempatektomi
Özet
Hiperhidrozis, sosyokültürel ilişkileri olumsuz etkileyen ve toplumda sıklıkla görülen aşırı terleme hastalığıdır. Sistemik bir nedene bağlı olmayan primer hiperhidroziste, sempatik sinir sisteminin hiperaktivasyonu mevcuttur. Konservatif medikal yöntemlere yanıt vermeyen hastalarda, Endoskopik Torasik Sempatektomi (ETS) %95’in üzerinde başarı oranıyla altın standart tedavi yöntemi olarak kabul edilmektedir. Cerrahi operasyonda, terlemeye neden olan bölgeye ulaşan sempatik liflerin koterizasyon, klipsleme veya raminektomi yöntemleriyle bloke edilmesi amaçlanır. ETS güvenli ve minimal invaziv bir girişim olmasına rağmen, vasküler kanamalar, parankim laserasyonu ve Horner sendromu gibi intraoperatif ile postoperatif komplikasyon riskleri barındırır. Operasyonun en önemli ve sık görülen uzun dönem yan etkisi ise gövde ve uyluk gibi bölgelerde ortaya çıkan kompansatuar (refleks) hiperhidrozistir. Blokaj seviyesinin yüksek olması bu riski artırmakta, güncel yaklaşımlarda kompansatuar terlemeyi azaltmak için uygun cerrahi seviyenin belirlenmesi ve hastaların ameliyat öncesi bilgilendirilmesi kritik önem taşımaktadır.
Hyperhidrosis is an excessive sweating disorder that negatively impacts socio-cultural relationships and has a higher prevalence in society than expected. In primary hyperhidrosis, which occurs without any underlying systemic diseases, there is a hyperactivation of the sympathetic nervous system. For patients unresponsive to conservative medical treatments, Endoscopic Thoracic Sympathectomy (ETS) is recognized as the gold standard treatment method with a success rate exceeding 95%. The primary goal of the surgical procedure is to block the sympathetic fibers leading to the affected area using methods such as cauterization, clipping, or ramicotomy. Although ETS is a safe and minimally invasive intervention, it carries risks of intraoperative and postoperative complications, including vascular hemorrhages, parenchymal laceration, and Horner syndrome. The most significant and common long-term side effect of the operation is compensatory (reflex) hyperhidrosis, typically developing in areas like the trunk and thighs. A higher level of surgical blockade increases this risk; therefore, determining the optimal surgical level and thoroughly informing patients preoperatively remain critical in current medical practices.
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