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assumed 'tags' in /websites/forum2008/viewthread.php(601) : regexp code on line 2 認識手掌多汗症 - 健康 - 噓!論壇 _ 無忌的論壇 ~ 歡迎芝麻小事,別聊國家大事 ~

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認識手掌多汗症

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認識手掌多汗症

人體內大約有300至500萬個汗腺,分布於全身皮膚底下的淺層部位。汗腺由交感神經控制,並隨環境、心情及溫度的改變而調節體溫及控制流汗量。每個人的排汗量並不一樣,在同一個環境下,一些人適量地流汗,但有些人卻汗流浹背。如果排汗量明顯超過調節體溫的需求,且沒有長期服用藥物,便有可能患上「多汗症」(hyperhidrosis)。多汗症可出現於全身或身體其中的一部分,以手掌多汗症 (palmar hyperhidrosis) 最為常見。

[B][color="purple"]遺傳及疾病可致多汗症[/B]

多汗症可分為原發性及繼發性兩種。原發性多汗症是因為交感神經反射亢進,所以引致患者大量出汗。有一半的患者有此症的家族史,遺傳因素則是其致病原因之一。

繼發性多汗症是由於身體系統性疾病或中樞神經系統症病所引致的,例如糖尿病、甲狀腺疾病、腦下垂體或下視丘部位的病變等。

原發性多汗症患者可以從兒童時期開始發病,隨後於青春期更為明顯。當患者處於稍熱的環境、心情緊張或進行輕量運動時,便會大量流汗,嚴重者會在任何情況下,大量出汗,雙手也滴下汗水。出汗部位以手掌為主,其次是足底和腋下。

[B][color="Purple"]手掌多汗症 對生活造成的影響[/B]

全球約有1%人口患有手掌多汗症,男女均有可能患病,但有研究指出,中國人及日本人較為常見。有人推算,本港可能至少有10萬人患有此症。

雖然手掌多汗症不是大病,亦不會威脅生命,但嚴重者卻可影響到生活質素,日常活動會受到限制,如寫字、運動及駕駛汽車等,繼而影響到工作表現或學業受到牽累。

廚師、電子工程師及文職人員等職業經常需要手部活動,而手掌多汗症使他們在工作方面造成不便。此外,手掌多汗症會影響患者的社交活動,增加心理壓力,常因手汗過多而不願意與別人接觸。

[B][color="purple"]非手術方法治療效果短暫[/B]

要治療手掌多汗症,患者需改變生活習慣,如減輕體重,保持心情愉快,也可服用藥物來控制交感神經的活動,不過因為其副作用較多,所以不宜隨便服用。

另外,亦可接受其他治療方法,包括使用含氯化鋁的外用止汗劑、注射肉毒桿菌素 (botox) 及離子電滲療法 (iontophoresis)。



1. 含氯化鋁的外用止汗劑

此法的好處是簡單易用,只需直接塗在手部便可,但只適用於輕微的手掌多汗症。使用數月後,止汗效果會漸漸減弱。



2. 肉毒桿菌素 (botox) 注射

此法是將肉毒桿菌素注射於手掌或腋下,阻止汗腺的神經傳遞,以抑制汗水分泌,但注射時會感到痛楚,止汗效果亦只可能維持幾個月,隨後仍需要再次注射。



3. 離子電滲療法(iontophoresis)

此法是利用電壓,將食水內的鈣引導至雙手的汗腺,從而抑制正常汗腺分泌,但每星期需進行數次,且止汗效果亦只可能維持幾個月,需要重複治療。

以上三種療法雖然可避免接受外科手術,可是只適用於輕微的手掌多汗症,且療效僅可維持數月,不能永久治療手掌多汗症。

[B][color="purple"]交感神經切除術[/B]

交感神經幹位於胸部上方,鄰近脊椎骨。由於汗腺是由交感神經控制,所以切除後可阻止其活動,手汗會自然消失。因此,交感神經切除術 (sympathectomy) 是一種比較有效治療手掌多汗症的方法。

交感神經切除術需要切開頸部或從腋下來進行,會造成較大的傷口。近年來,改用微創內視鏡技術進行,此手術名為「胸腔內視鏡交感神經切除術」(VATS sympathectomy),其成功率極高。

醫生會在患者左右兩邊的腋下部位切開2至3個大約10至20毫米的小創口,然後利用內視鏡進入胸腔,切除交感神經幹。

[B][color="purple"]嶄新的針孔式 超微創胸腔鏡手術[/B]

近年,香港大學李嘉誠醫學院外科學系在葛量洪醫院心胸肺外科部引進新一代的超微創手術,名為「針孔式超微創胸腔鏡手術」(needlescopic VATS)。

醫生在患者兩側腋下部位切開2至3個約2至3毫米的小創口,便可切除交感神經幹,手術時間只需30至45分鐘。由於此手術器材非常細小,有如一根竹簽,所以創口極小,痛楚大大減少,患者可在短期內復元而縮短住院日子。

[B][color="purple"]切除交感神經後的注意事項[/B]

一般來說,術後不會影響健康,且手術危險性極低,所以現已被廣泛使用,可是切除交感神經後也會有機會出現後遺症。因為手部的排汗量減少,身體其他部位自然會多出汗,例如腹部或背部,這情況稱為「代償性多汗」(compensatory sweating),屬於最常見的一種。

國際研究顯示,近30至95% 患者會於手術後出現代償性多汗,但程度往往輕微。嚴重的後遺症極為罕見,包括面部變乾、霍納氏綜合徵 (即患者會出現眼皮下垂及瞳孔形狀不一等症狀) 及嚐味性多汗 (即在進食時不斷流汗)。因此,患者在接受手術前,應向胸肺外科專科醫生了解手術的後遺症,因為這些後遺症是不能治癒的。

香港大學心胸肺外科部在葛量洪醫院研究使用針孔式超微創胸腔鏡手術治療手掌多汗症的效果,初步結果顯示此手術可有效地治療手掌多汗症,其成功率近100%,而復發率則低於1%。

此外,手術後可全面改善生活質素,滿意程度高達97%。現時,我們將進一步進行多項臨床研究,包括手術後的長遠影響、減少手術痛楚的方法、減少後遺症的方法及手術對患者的身心發展等,希望將來可將針孔或胸腔鏡手術加以改良,成為一種日間手術,讓患者可以手術後即日回家,無需住院。
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