Phillips M J, Cowan A R, Johnson C D
Royal South Hants Hospital, Southampton.
Ann R Coll Surg Engl. 1997 Jul;79(4):264-7.
This debate examines the proposition that surgery is unnecessary or obsolete in the management of intermittent claudication. The case for this argument is that many patients have stable disease or respond well to conservative measures, that claudication is an expression of a systemic cardiovascular illness and that surgery can be replaced by endovascular techniques with equal success, and less disadvantage in the event of treatment failure. The case against the motion is that claudication is associated with repeated cycles of ischaemia and reperfusion, and that these contribute to excess cardiovascular mortality states and, furthermore, that surgery is the only option to relieve symptoms for many patients, especially those with distal disease.
本次辩论探讨的命题是,在间歇性跛行的治疗中,手术是不必要的或已过时。支持这一论点的理由是,许多患者病情稳定或对保守治疗反应良好;间歇性跛行是全身性心血管疾病的一种表现;手术可被血管内技术取代,且成功率相同,治疗失败时劣势更小。反对该命题的理由是,间歇性跛行与缺血和再灌注的反复循环相关,这会导致心血管死亡率过高;此外,手术是许多患者缓解症状的唯一选择,尤其是那些患有远端疾病的患者。