Lau H, Cheng S W
Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Aust N Z J Surg. 1997 May;67(5):264-9. doi: 10.1111/j.1445-2197.1997.tb01960.x.
A retrospective analysis of 103 case records from 1978 to 1996 with a provisional diagnosis of Buerger's disease was undertaken at the Department of Surgery, University of Hong Kong, Queen Mary Hospital. The aim of the study was to elucidate the clinical course and evaluate the results of surgical intervention of Buerger's disease in Hong Kong Chinese people.
Fourteen patients were subsequently excluded from the study because of inability of fulfil our diagnostic criteria. Data on clinical presentation, investigations, indications and results of surgical intervention were reviewed. Sympathectomies and arterial reconstructions were performed on 42 and four patients, respectively, for critical ischaemia or rest pain. Outcome was analysed with respect to the rate of ulcer healing, pattern of recurrence and limb loss.
The patients were all young male heavy smokers with a mean age of 36.5 years. The majority of patients (80%) presented with ischaemic ulceration or gangrene. Vascular reconstruction was undertaken in four patients and satisfactory long-term results were obtained in three patients. Sympathectomy was able to relieve symptoms in 87% of operated patients and ischaemic ulceration healed in 2.6 (mean) +/- 1.7 (SD) months after the operation. If the patient continued to smoke, surgical intervention did not exempt the patient from a relapse or amputation.
Sympathectomy provides short-term pain relief and promotes ulcer healing in patients with Buerger's disease but carries no long-term benefit. Complete abstinence from smoking is the only means of arresting the progression of the disease.
香港大学玛丽医院外科对1978年至1996年间103例初步诊断为血栓闭塞性脉管炎的病例记录进行了回顾性分析。本研究的目的是阐明血栓闭塞性脉管炎的临床病程，并评估香港华人患者手术干预的效果。
随后有14例患者因不符合我们的诊断标准而被排除在研究之外。回顾了临床表现、检查、手术干预的指征和结果等数据。分别对42例和4例患者进行了交感神经切除术和动脉重建术，以治疗严重缺血或静息痛。分析了溃疡愈合率、复发模式和肢体丧失情况等结果。
患者均为年轻男性重度吸烟者，平均年龄36.5岁。大多数患者（80%）表现为缺血性溃疡或坏疽。4例患者接受了血管重建术，3例患者获得了满意的长期效果。交感神经切除术使87%的手术患者症状得到缓解，术后缺血性溃疡在2.6（平均）±1.7（标准差）个月愈合。如果患者继续吸烟，手术干预并不能使患者免于复发或截肢。
交感神经切除术可缓解血栓闭塞性脉管炎患者的短期疼痛并促进溃疡愈合，但无长期益处。完全戒烟是阻止疾病进展的唯一方法。
