Hartzell Tristan L, Makhni Eric C, Sampson Christian
Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
J Hand Surg Am. 2009 Oct;34(8):1454-60. doi: 10.1016/j.jhsa.2009.05.003. Epub 2009 Aug 15.
To compare long-term results (minimum follow-up of 23 months) of periarterial sympathectomy for patients with digital vasospasm secondary to either an autoimmune disease or generalized atherosclerotic disease. Patients with posttraumatic or localized occlusive disease and vasospasm were not evaluated.
Twenty-eight patients had periarterial sympathectomy at 1 hospital by 1 senior surgeon. Periarterial sympathectomy was targeted to the areas of ulceration. Twenty patients (with 24 involved extremities and 42 ulcerated digits) had a documented autoimmune disease; 17 patients had scleroderma or an undifferentiated mixed connective tissue disorder, 2 had systemic lupus erythematosus, and 1 had rheumatoid arthritis. Eight patients (with 9 involved extremities and 17 ulcerated digits) had atherosclerotic disease. The primary outcomes were complete healing of all ulcers, a decrease in the number of ulcers, and need for amputation by the end of follow-up. Statistical analysis was done using the Fischer exact t-test.
The average follow-up for all patients was 96 months (90 months for the autoimmune group and 113 months for the atherosclerotic group). Fifteen of the 20 patients (28 of 42 digits) in the autoimmune group had complete healing or decrease in ulcer number. Conversely, only 1 of the 8 patients (2 of 17 digits) in the atherosclerotic group had complete healing or decrease in ulcer number. Eleven of the 42 (26%) digits treated in the autoimmune group required amputation. In contrast, 10 of the 17 (59%) digits treated in the atherosclerotic group ultimately required amputation.
Periarterial sympathectomy can lead to complete healing and decrease in ulcer number in autoimmune disease patients with digital ischemia from vasospasm. However, our data suggest that periarterial sympathectomy may be of little or no benefit in patients with chronic digital ischemia and vasospasm secondary to severe atherosclerotic disease.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
比较因自身免疫性疾病或全身性动脉粥样硬化疾病继发指端血管痉挛患者接受动脉周围交感神经切除术的长期结果（最短随访23个月）。未评估创伤后或局限性闭塞性疾病及血管痉挛患者。
1名资深外科医生在1家医院为28例患者实施了动脉周围交感神经切除术。动脉周围交感神经切除术针对溃疡部位。20例患者（24个受累肢体和42个溃疡指端）患有确诊的自身免疫性疾病；17例患有硬皮病或未分化的混合性结缔组织病，2例患有系统性红斑狼疮，1例患有类风湿关节炎。8例患者（9个受累肢体和17个溃疡指端）患有动脉粥样硬化疾病。主要结局为随访结束时所有溃疡完全愈合、溃疡数量减少以及是否需要截肢。采用Fisher精确t检验进行统计分析。
所有患者的平均随访时间为96个月（自身免疫组90个月，动脉粥样硬化组113个月）。自身免疫组20例患者中的15例（42个指端中的28个）溃疡完全愈合或数量减少。相反，动脉粥样硬化组8例患者中只有1例（17个指端中的2个）溃疡完全愈合或数量减少。自身免疫组治疗的42个指端中有11个（26%）需要截肢。相比之下，动脉粥样硬化组治疗的17个指端中有10个（59%）最终需要截肢。
动脉周围交感神经切除术可使因血管痉挛导致指端缺血的自身免疫性疾病患者的溃疡完全愈合且数量减少。然而，我们的数据表明，动脉周围交感神经切除术对严重动脉粥样硬化疾病继发慢性指端缺血和血管痉挛的患者可能益处不大或没有益处。
研究类型/证据水平：治疗性III级。
