Lefaucheur J P, Becquemin J P, Brugières P, Verroust J
Department of Physiology, Henri Mondor Hospital, Creteil, France.
J Auton Nerv Syst. 1996 Aug 27;60(1-2):56-60. doi: 10.1016/0165-1838(96)00035-5.
The place of lumbar sympathectomy in the treatment of occlusive arterial disease of the lower limbs remains controversial. An adequate assessment of sympathetic nerve function in the practice of sympathectomy may reduce unsatisfactory results of this procedure. We report a series of 25 lumbar sympatholyses indicated for claudication, rest pain or distal arterial ulcer, and attempted by means of phenol injection in sympathetic ganglia under tomographic guidance. Sympathetic skin response (SSR) recording, an electrophysiological test of sympathetic activity, was performed before and after phenol injection, and its results were compared to the clinical outcome. SSR was abolished in the treated limb after phenol injection in only 64% of the cases. The post-injection abolition of SSR was correlated with the clinical improvement rate: 11% when SSR was still present, but 75% when SSR was abolished. In this latter case, the pre-injection values of SSR amplitudes could predict the clinical benefit of sympatholysis. It is necessary to assess the sympathetic activity in a limb before and after doing sympatholysis. Preoperatively, this activity may be diminished or already abolished in patients suffering from neuropathy involving the autonomic nervous system, limiting the indication of sympathectomy. Postoperatively, if sympathetic activity is still present in the treated limb, it implies that the sympathectomy is not completed, and it supports the indication of a new sympatholysis attempt. These observations show the usefulness of SSR recording in the practice of phenol sympatholysis, this test being simple and specific of sympathetic nerve function.
腰交感神经切除术在下肢闭塞性动脉疾病治疗中的地位仍存在争议。在交感神经切除术实践中对交感神经功能进行充分评估，可能会减少该手术不尽人意的结果。我们报告了一系列25例因间歇性跛行、静息痛或远端动脉溃疡而进行的腰交感神经松解术，这些手术是在断层扫描引导下通过向交感神经节注射苯酚来尝试完成的。在注射苯酚前后进行了交感皮肤反应（SSR）记录，这是一种交感神经活动的电生理测试，并将其结果与临床结果进行了比较。注射苯酚后，仅64%的病例中治疗侧肢体的SSR消失。注射后SSR的消失与临床改善率相关：SSR仍存在时为11%，而SSR消失时为75%。在后一种情况下，注射前SSR振幅值可以预测交感神经松解术的临床获益。在进行交感神经松解术前后评估肢体的交感神经活动是必要的。术前，对于患有累及自主神经系统的神经病变的患者，这种活动可能会减弱或已经消失，这限制了交感神经切除术的适应症。术后，如果治疗侧肢体仍存在交感神经活动，这意味着交感神经切除术未完成，并且支持再次尝试交感神经松解术的适应症。这些观察结果表明SSR记录在苯酚交感神经松解术实践中的有用性，该测试简单且对交感神经功能具有特异性。
