Rappaport W D, Valente J, Hunter G C, Rance N E, Lick S, Lewis T, Neal D
Department of Surgery, University of Arizona Medical Center, Tucson 85724.
Am J Surg. 1993 Sep;166(3):252-6. doi: 10.1016/s0002-9610(05)80968-7.
Surgeons frequently perform sural nerve biopsy as part of the work-up of patients with peripheral neuropathy. The indications for the procedure, therapeutic value, and complications associated with the procedure have received little attention in the surgical literature. A retrospective chart review of 60 patients with the suspected diagnosis of peripheral neuropathy undergoing sural nerve biopsy was performed. Vasculitis was suspected in 29 (48%) patients undergoing biopsy. This diagnosis was confirmed in 6 of the 29 patients and resulted in the alteration of therapy in 31% of patients with this suspected diagnosis. In 27 (45%) patients, the etiology of their peripheral neuropathy was unknown. Twelve (44%) patients in this group had sural nerve pathology; however, no change in therapy was required. Ten patients in our series had associated malignant tumors; some of these patients were diagnosed after referral for sural nerve biopsy. Twenty-five (42%) patients remained undiagnosed after biopsy. Nerve conduction studies were performed in 14 (22%) patients. Thirteen patients with abnormal lower extremity nerve conduction studies had 6 normal and 7 abnormal biopsy results. The one patient with a normal study had a normal nerve biopsy result. There were six (10%) patients with wound infections, seven (12%) patients with delayed wound healing, and three (5%) patients with new onset of chronic pain in the distribution of the sural nerve, for an overall complication rate of 27%. There was no correlation between the preoperative use of antibiotics, type of local anesthetic used, or length of nerve excised and complication rate. We conclude that the complication rate after sural nerve biopsy is significant. Strict criteria should be employed in selecting patients for sural nerve biopsy including a careful neurologic history and physical examination, nerve conduction studies, appropriate work-up for vasculitis if suspected, and implementation of a search for malignancy if this is not apparent. If the diagnosis is still in question, then sural nerve biopsy would seem appropriate, especially in patients with suspected vasculitis.
外科医生经常将腓肠神经活检作为周围神经病变患者检查工作的一部分。该手术的适应症、治疗价值以及与之相关的并发症在外科文献中很少受到关注。我们对60例疑似周围神经病变并接受腓肠神经活检的患者进行了回顾性病历审查。29例（48%）接受活检的患者怀疑患有血管炎。29例患者中有6例确诊，且31%怀疑患有血管炎的患者因此改变了治疗方案。27例（45%）患者周围神经病变的病因不明。该组中有12例（44%）患者存在腓肠神经病理改变；然而，无需改变治疗方案。我们系列研究中的10例患者伴有恶性肿瘤；其中一些患者是在因腓肠神经活检转诊后确诊的。25例（42%）患者活检后仍未确诊。14例（22%）患者进行了神经传导研究。13例下肢神经传导研究异常的患者，活检结果6例正常，7例异常。1例研究结果正常的患者神经活检结果也正常。有6例（10%）患者发生伤口感染，7例（12%）患者伤口愈合延迟，3例（5%）患者在腓肠神经分布区域出现新发慢性疼痛，总体并发症发生率为27%。术前使用抗生素、所用局部麻醉剂类型或切除神经的长度与并发症发生率之间无相关性。我们得出结论，腓肠神经活检后的并发症发生率较高。在选择进行腓肠神经活检的患者时应采用严格标准，包括仔细的神经病史和体格检查、神经传导研究、如果怀疑血管炎进行适当检查以及如果未发现明显恶性肿瘤则进行恶性肿瘤排查。如果诊断仍有疑问，那么腓肠神经活检似乎是合适的，尤其是在疑似血管炎的患者中。
