Kim G E, Ibrahim I M, Imparato A M
Ann Surg. 1976 Feb;183(2):157-60. doi: 10.1097/00000658-197602000-00012.
Sixty-one patients had lumbar sympathectomies performed for end stage occlusive vascular disease manifested by gangrene of less than one-half of the foot, ulcerating ischemic lesions, rest pain or rapidly progressive markedly limiting intermittent claudication. The operative procedure was standardized to permit removal of the lowermost preganglionic fiber at the level of the crus of the diaphragm and the ganglionated chain to the crossing of the iliac vessels. The immediate postoperative mortality was 6.5% from cardiac causes. Over all improvement rate was 60% while early amputation rate was 40% for the entire group. Those patients with rest pain had the poorest prognosis with an amputation rate of 53%. The results are compared to other groups and factors of patient selection, anatomy of the sympathetic chain in relation to operative technique, physiology of decentralization versus devervation are discussed. The procedure is worthwhile in patients who are not candidates for arterial reconstruction who are faced with the prospect of early amputation.
61例患者因终末期闭塞性血管疾病接受了腰交感神经切除术，这些疾病表现为足部坏死面积小于一半、溃疡性缺血性病变、静息痛或快速进展且严重限制间歇性跛行。手术操作标准化，以便在膈肌脚水平切除最下方的节前纤维以及至髂血管交叉处的神经节链。术后立即因心脏原因导致的死亡率为6.5%。整个组的总体改善率为60%，而早期截肢率为40%。有静息痛的患者预后最差，截肢率为53%。将结果与其他组进行了比较，并讨论了患者选择因素、与手术技术相关的交感神经链解剖结构、去神经支配与去传入神经支配的生理学。对于那些不适合进行动脉重建且面临早期截肢前景的患者，该手术是值得的。
