Clinical Investigation of Sympathetic Nerve Width Measurement in Thoracoscopic Sympathectomy

Clinical Investigation of Sympathetic Nerve Width Measurement in Thoracoscopic Sympathectomy

This prospective, single-center observational study evaluates the clinical utility of intraoperative sympathetic nerve width measurement during thoracoscopic sympathectomy (ETS) for palmar/craniofacial hyperhidrosis (PH/CH) and facial blushing (FF). The study aims to correlate nerve width-measured using a novel Rapid Intraoperative Sympathetic Nerve Width System (RMSNW-OS) (±0.2mm precision)-with surgical outcomes, compensatory sweating rates, patient satisfaction, and 12-month efficacy.

Approximately 1,000 patients (aged 18-55) will undergo standardized ETS at Shanghai First People's Hospital (2025-2029). Objective metrics include thermographic (palmar/forehead temperature), hemodynamic (HR/BP), biochemical (catecholamines), and Doppler flow measurements. Patient-reported outcomes use diagnosis-specific binary questionnaires and the Hyperhidrosis Disease Severity Scale (HDSS).

Statistical analysis will determine if nerve width predicts treatment response. Innovations include RMSNW-OS standardization and a multidimensional assessment framework to optimize ETS precision and patient quality of life.

Inclusion Criteria:

1. Diagnosis : Confirmed autonomic nervous dysfunction (including palmar hyperhidrosis, craniofacial hyperhidrosis, or facial blushing).

2. Age : ≥18 years and ≤55 years.

3. Cardiopulmonary Function :

   Normal preoperative chest CT scan and electrocardiogram (ECG).

4. Performance Status : ECOG score (see Attachment 1) of 0-1, indicating good clinical fitness and ability to perform daily activities independently.

5. Informed Consent : Patients and their families fully understand the study's purpose, procedures, risks, and potential benefits, voluntarily sign the Informed Consent Form, and agree to participate.

Exclusion Criteria:

1. Abnormal Preoperative ECG :

1. Severe arrhythmias:

   1. Type II second-degree or higher atrioventricular block.
   2. Symptomatic ventricular arrhythmias.
   3. Uncontrolled supraventricular arrhythmias (resting heart rate >100 bpm). These may cause inadequate cardiac output, hypoperfusion of vital organs, and increased surgical risk.

2. Myocardial ischemia or infarction:

   1. ECG showing ST-segment elevation/depression, T-wave inversion.
   2. Pathological Q-waves indicating myocardial infarction. 2. Abnormal Chest CT :

1) Severe pulmonary infections (e.g., lobar pneumonia, empyema) with symptoms like fever, cough, dyspnea. Surgery increases infection risk and may lead to atelectasis or respiratory failure.

2) Pneumothorax or tension pneumothorax:

1. Significant lung collapse causing dyspnea.

2. Tension pneumothorax requiring immediate chest tube drainage. 3) Pleural effusion (moderate/large volume): Causes dyspnea or mediastinal shift; surgery may worsen respiratory function.

   3. Hyperthyroidism-induced facial blushing or generalized hyperhidrosis. 4. Anesthesia Contraindications : Allergy to anesthetics or high-risk conditions (severe pulmonary/cardiac dysfunction).

   5. Cognitive/Psychiatric Impairment : Inability to provide informed consent or understand study risks.

   6. Non-Compliance with Follow-up : Inability to adhere to postoperative visits.

   7. Immunodeficiency Disorders : Severe immunodeficiency, AIDS, or organ transplant history.

   8. Frailty/Advanced Age : Elderly patients with comorbidities or functional decline unfit for surgery.

   9. Severe Organ Dysfunction : Cirrhosis, renal failure, or inability to tolerate surgery/recovery.

   10. Active Infections : Under antibiotic treatment for pneumonia, tuberculosis, or bacterial infections.

   11. Uncontrolled Diabetes : Poor glycemic control with complications (retinopathy, diabetic foot).

   12. Concurrent Clinical Trials : Participation in other interventional studies affecting results.

   13. Severe Malnutrition : Significant weight loss or nutritional deficiency increasing anesthesia/surgical risks.

   14. Hematologic Disorders : Anemia, thrombocytopenia, or coagulopathies affecting hemostasis/recovery.

   15. Severe Chronic Respiratory Failure : Long-term ventilator dependence or tracheostomy.