Ohta T, Shionoya S
Second Department of Surgery, Medical University, Japan.
Br J Surg. 1988 Mar;75(3):259-62. doi: 10.1002/bjs.1800750324.
The clinical course of 328 patients with Buerger's disease (thromboangiitis obliterans: TAO) was followed. Neither ischaemic ulcers nor gangrene occurred in 26 per cent of the patients. Almost all of the ulcers occurred in patients between 20 and 50 years of age, with a peak incidence between 40 and 45 years. The younger the patient at the onset of the disease, the later the first ulcer occurred, and the later the first ulcer occurred, the shorter the period in which ulceration may recur. Recurrent ulcers were observed in 45 per cent of the patients. The progression of symptoms was influenced by smoking, but this was not the only deleterious factor as there were patients with stable TAO unaffected by smoking. In the 30 patients over the age of 60 years, ulceration and gangrene were not observed. In all patients, the progression of symptoms was self-limited and recurrent ulcers occurred less frequently with ageing. The rate of major amputation was low (3.9 per cent) although minor digital amputations were sometimes required. The survival rate of patients with TAO was higher than that of patients with arteriosclerosis obliterans. The aim of treatment in patients with TAO is to make patients abstain from smoking to prevent ulceration and to shorten the period of healing of trophic lesions without major amputation, as ulceration and gangrene in T AO are limited to the most distal part of the limbs, and seems to have healing potential.
对328例血栓闭塞性脉管炎（TAO）患者的临床病程进行了跟踪观察。26%的患者未出现缺血性溃疡和坏疽。几乎所有溃疡都发生在20至50岁的患者中，40至45岁发病率最高。发病时患者年龄越小，首次出现溃疡的时间越晚，而首次出现溃疡的时间越晚，溃疡复发的周期越短。45%的患者出现复发性溃疡。症状的进展受吸烟影响，但这并非唯一有害因素，因为有一些血栓闭塞性脉管炎病情稳定的患者不受吸烟影响。在60岁以上的30例患者中，未观察到溃疡和坏疽。在所有患者中，症状进展具有自限性，且随着年龄增长复发性溃疡发生频率降低。尽管有时需要进行小截肢，但大截肢率较低（3.9%）。血栓闭塞性脉管炎患者的生存率高于闭塞性动脉硬化患者。血栓闭塞性脉管炎患者的治疗目标是使患者戒烟，以预防溃疡并缩短营养性病变愈合时间而无需进行大截肢，因为血栓闭塞性脉管炎的溃疡和坏疽仅限于肢体最远端部位，且似乎具有愈合潜力。
