Becquemin J P, Kassab M, Bellouard A, Brugière P, Mellière D
Service de chirurgie vasculaire, Hôpital Henri-Mondor, Créteil.
J Mal Vasc. 1989;14(4):327-33.
Lumbar sympathectomy, which is usually indicated in the arteritic patient in cases of severe ischemia and occlusion of leg arteries when bypass surgery is not feasible, can be performed surgically or by scanner-guided phenolization. Surgical sympathectomy was performed by resection of the 2nd, 3rd, 4th and 5th lumbar ganglia under general anesthesia by a retroperitoneal route. Chemical sympathectomy involved scanner-guided injection of phenol diluted 6.7% into the sympathetic nervous system at L3 and L4 level. This act, performed on outpatients, required no anesthesia. Prospective study of the early results (within one month) obtained with these two techniques in 428 patients indicates that rates of death, amputation and noteworthy complications for those less than 70 yr (table IV, VI and VIII) were respectively 4.7%, 8.5% and 7.4% for surgery, and 2.5%, 5% and 0% for phenolization; for those greater than 70 yr the rates were respectively 12%, 11% and 10% for surgery, and 10%, 9% and 8% for phenolization. It may be concluded that phenolization of the sympathetic nervous system provides the same results as surgical sympathectomy but has the advantage of lower morbidity and shorter hospitalization (24 h vs 10 days). The results of these two techniques in terms of limb conservation are disappointing and markedly poorer than those of distal bypass surgery.
腰交感神经切除术通常适用于动脉炎患者，当腿部动脉严重缺血和闭塞且旁路手术不可行时，可通过手术或扫描仪引导下的酚化术进行。手术腰交感神经切除术是在全身麻醉下通过腹膜后途径切除第2、3、4和5腰神经节。化学性腰交感神经切除术是在扫描仪引导下将6.7%稀释的酚注入L3和L4水平的交感神经系统。该操作在门诊患者中进行，无需麻醉。对428例患者采用这两种技术获得的早期结果（1个月内）进行的前瞻性研究表明，70岁以下患者（表IV、VI和VIII）手术的死亡率、截肢率和显著并发症发生率分别为4.7%、8.5%和7.4%，酚化术分别为2.5%、5%和0%；70岁以上患者手术的发生率分别为12%、11%和10%，酚化术分别为10%、9%和8%。可以得出结论，交感神经系统酚化术与手术腰交感神经切除术效果相同，但具有发病率较低和住院时间较短（24小时对10天）的优势。这两种技术在保肢方面的结果令人失望，明显比远端旁路手术的结果差。
