Nesargikar Prabhu N, Ajit M K, Eyers Paul S, Nichols Barry J, Chester John F
Department of Vascular Surgery and Anaesthesia, Taunton and Somerset NHS Trust, Musgrove Park, Taunton TA1 5DA, United Kingdom.
Int J Surg. 2009 Apr;7(2):145-9. doi: 10.1016/j.ijsu.2009.01.004. Epub 2009 Jan 27.
Lumbar chemical sympathectomy (LCS) is used principally in inoperable peripheral vascular disease (PVD) to alleviate symptoms of rest pain and as an adjunct to other treatments for ulcers. No guidelines currently exist in the UK for its use in PVD. The aim of this study was to evaluate the role of LCS with regard to indications and outcomes in the UK and Irish vascular surgical practice.
Specifically designed questionnaires were sent to Vascular Surgical Society members. The questions related to their current use of LCS including indications, outcome parameters, use in diabetics and complications encountered.
Four hundred and ninety postal questionnaires were sent out and 242 responses (49%) were received. Seventy five percent of the respondents (n=183) felt that LCS had a role in current practice. Seventy eight percent (n=144) performed less than 10 procedures per year and 3% (n=5) more than 20 per year. Eighty percent (n=145) were performed by anaesthetists, 12% (n=23) by radiologists and 8% (n=15) by surgeons. Inoperable peripheral vascular disease with rest pain was the main indication in over 80% of responses with 27% using it for the treatment of ulcers. Only 21% used LCS in diabetics. Clinical improvement was used to assess the outcome following LCS in 96% of responses. Complications included neuralgia, ureteric damage and paraplegia following inadvertent extradural injection.
Although no clear guidance exists for the use of LCS in PVD, the majority of respondents continue to use it. Indications and outcomes are documented in this study of UK and Irish vascular surgical practice.
腰交感神经化学切除术（LCS）主要用于无法进行手术的外周血管疾病（PVD），以缓解静息痛症状，并作为溃疡其他治疗方法的辅助手段。目前英国尚无关于其在PVD中应用的指南。本研究的目的是评估LCS在英国和爱尔兰血管外科实践中的适应证及治疗效果。
向血管外科学会成员发送了专门设计的调查问卷。问题涉及他们目前对LCS的使用情况，包括适应证、疗效参数、在糖尿病患者中的使用情况以及遇到的并发症。
共发出490份邮政调查问卷，收到242份回复（49%）。75%的受访者（n = 183）认为LCS在当前实践中有作用。78%（n = 144）的受访者每年进行少于10例手术，3%（n = 5）的受访者每年进行超过20例手术。80%（n = 145）的手术由麻醉师进行，12%（n = 23）由放射科医生进行，8%（n = 15）由外科医生进行。超过80%的回复中，无法进行手术的伴有静息痛的外周血管疾病是主要适应证，27%的受访者将其用于溃疡治疗。只有21%的受访者在糖尿病患者中使用LCS。96%的回复中使用临床改善情况来评估LCS后的疗效。并发症包括神经痛、输尿管损伤以及硬膜外意外注射后的截瘫。
尽管目前尚无关于LCS在PVD中应用的明确指南，但大多数受访者仍继续使用。本研究记录了英国和爱尔兰血管外科实践中的适应证及治疗效果。
