Holiday F A, Barendregt W B, Slappendel R, Crul B J, Buskens F G, van der Vliet J A
Department of Surgery, St. Radboud University Hospital, Nijmegen, The Netherlands.
Cardiovasc Surg. 1999 Mar;7(2):200-2. doi: 10.1016/s0967-2109(97)00094-x.
The value of surgical and chemical lumbar sympathectomy was studied in patients with critical lower-limb ischaemia without the option of vascular reconstruction. Clinical success rates, defined as improvement of ischaemia stage, and limb salvage rates were recorded for 76 limbs of 70 consecutive patients. Chemical lumbar sympathectomy patients were older and had more concomitant diseases than surgical lumbar sympathectomy patients. The short-term (6-week) success rate in 36 cases treated with surgical lumbar sympathectomy (44%) was better than in 40 cases treated with chemical lumbar sympathectomy (18%) (P = 0.01). The long-term (1-year) success rate was 47% for surgical lumbar sympathectomy and 45% for chemical lumbar sympathectomy (P = NS). The 1-year limb salvage rates were 61% for surgical lumbar sympathectomy and 58% for chemical lumbar sympathectomy (P = NS). Complications were minor in both groups. Lumbar sympathectomy still has a limited role in the treatment of critical limb ischaemia in patients without the option of vascular reconstruction. Both surgical and chemical lumbar sympathectomy can be performed with very little morbidity and may provide a benefit over the natural course of the arterial insufficiency.
在无法进行血管重建的严重下肢缺血患者中，对手术和化学性腰交感神经切除术的价值进行了研究。记录了连续70例患者76条肢体的临床成功率（定义为缺血阶段改善）和肢体挽救率。化学性腰交感神经切除术患者比手术性腰交感神经切除术患者年龄更大，合并症更多。手术性腰交感神经切除术治疗的36例患者的短期（6周）成功率（44%）优于化学性腰交感神经切除术治疗的40例患者（18%）（P = 0.01）。手术性腰交感神经切除术的长期（1年）成功率为47%，化学性腰交感神经切除术为45%（P = 无显著性差异）。手术性腰交感神经切除术的1年肢体挽救率为61%，化学性腰交感神经切除术为58%（P = 无显著性差异）。两组并发症均较轻。在无法进行血管重建的严重肢体缺血患者的治疗中，腰交感神经切除术的作用仍然有限。手术和化学性腰交感神经切除术的发病率都很低，并且可能比动脉供血不足的自然病程更有益。
