Olcott C, Eltherington L G, Wilcosky B R, Shoor P M, Zimmerman J J, Fogarty T J
Department of Cardiovascular Surgery, Sequoia Hospital, Redwood City.
J Vasc Surg. 1991 Oct;14(4):488-92; discussion 492-5. doi: 10.1067/mva.1991.30276.
It is important for vascular surgeons to be familiar with reflex sympathetic dystrophy because they may be called on to participate in the evaluation and treatment of patients with this syndrome. Over a 3 1/2-year period, 35 patients, initially evaluated by a team of pain experts, were referred for surgical sympathectomy for reflex sympathetic dystrophy. All patients had at least one positive diagnostic sympathetic block before they were considered for surgical sympathectomy. With use of this team approach and careful patient selection, excellent results were obtained in 74%, good results in 17%, and poor results in 9%. Three patients required a repeat cervical sympathectomy after initial surgery failed to relieve their symptoms. One patient required a contralateral lumbar sympathectomy after ipsilateral sympathectomy was unsuccessful. Better results were obtained in patients treated earlier in their course and with extended surgical sympathectomy. Patients not responding to initial sympathectomy should be evaluated for the presence of residual functional sympathetic tissue, and if this is identified, further sympathectomy by an alternate approach appears justified.
血管外科医生熟悉反射性交感神经营养不良很重要，因为他们可能会被要求参与该综合征患者的评估和治疗。在3年半的时间里，35名最初由疼痛专家团队评估的患者因反射性交感神经营养不良被转诊接受手术交感神经切除术。所有患者在考虑接受手术交感神经切除术之前至少有一次诊断性交感神经阻滞阳性。采用这种团队协作方法并仔细挑选患者，74%的患者获得了优异结果，17%的患者结果良好，9%的患者结果不佳。3例患者在初次手术未能缓解症状后需要再次进行颈交感神经切除术。1例患者在同侧交感神经切除术后未成功，需要进行对侧腰交感神经切除术。病程早期接受治疗且进行了扩大手术交感神经切除术的患者获得了更好的结果。对初次交感神经切除术无反应的患者应评估是否存在残留的功能性交感神经组织，如果发现存在，采用另一种方法进行进一步的交感神经切除术似乎是合理的。
