Therapeutic feasibility of percutaneous puncture and chemical neurolysis of thoracic sympathetic nerve block in palmar hyperhidrosis under the guidance of computed tomograph

Objective To explore the therapeutic feasibility of percutaneous puncture and neurolytic thoracic sympathetic nerve block under the guidance of computed tomograph (CT).Methods From September 2009 to August 2010,23 cases with primary palmar hyperhidrosis underwent percutaneous puncture and neurolytic thoracic sympathetic nerve block at our hospital.The puncture of thoracic sympathetic nerve was guided by CT through the gap of T3-4.The screen showed the direction of needle and the location of needle tip at the upper joint of costal head beside T3 body and outside of costal pleura.A mixed injection of 1％ lidocaine and 30％ iohexol was administered.On CT,lidocaine was found to cover the area where the thoracic sympathetic nerve was located.And after several minutes,the patient's palms turned warm and dry from cool and wet without the onset of Homer's syndrome.Then 2.5 ml of absolute alcohol was injected to block the thoracic sympathetic nerve.Results CT could guide the needle to the right position.And the injectate spreaded to the site of thoracic sympathetic nerve.At 5 min after anesthetic injection,the palmar temperature raised an average of 2.86 ℃ and the amplitude of pulse rose over 55％.Palmar hyperhidrosis was cured in 19 patients by one attempt and 4 patients required a second block with absolute alcohol.No complication occurred and there were 2 patients with tendency of recurrence during a follow-up period of 8 - 18 months.Conclusion The CT-guided therapy of percutaneous puncture and chemical neurolysis of thoracic sympathetic nerve block is both feasible and efficacious for palmar hyperhidrosis. Key words: Hyperhidrosis;  Autonomous nervous system;  Sympathetic chain