Nakajima N
First Department of Surgery, Faculty of Medicine, Chiba University, Japan.
Int J Cardiol. 1998 Oct 1;66 Suppl 1:S273-80; discussion S281. doi: 10.1016/s0167-5273(98)00179-x.
Buerger's disease was originally described by Leo Buerger in 1908 as thromboangitis obliterance and has been considered as one of the most intractable vasculitis syndromes in our country. This lesion is popularly seen in male young generation with a background history of heavy smoking. Buerger's disease in Japan has been frequently seen in our practice; however, it is noted that there have been certain definitive changes in relation to number of patients, clinical manifestation as well as course of treatment in particular in surgical treatment. Firstly, the number of patients who visited at outpatient clinic as well as to admit hospital has been sharply declined. Secondly, the number of surgical treatments of Buerger's disease have also decreased. The sympathectomy, mainly lumbal sympathectomy, which was maintained at about 15 to 20% of the number of patients admitted, was virtually abolished from the practice and mainly converted to the medical and pharmacological treatment by prostaglandin. The reliability of pharmacological sympathectomy is one of the other reasons which contributed to the shift of treatment. It is also our impression that the severity of the disease itself has been changed, in other words, we do not frequently see very severely ill patients. As far as surgery is concerned the important modality in the treatment for the advanced lesion of Buerger's disease is mainly confined in small arteries with multisegmental occlusion. As a consequence, the surgical reconstructive procedures are technically difficult and long term patency rate is considered to be low. As far as our experience is concerned, it is noted that the number of bypass surgery was most frequently seen at below trifurcation segment of knee joint; in other words, peripheral, distal type bypass was the most popular, followed by above knee segment. The reconstructive surgery at femoral region was least frequently seen. On the other hand, the patency rate of bypass graft was higher in the proximal segment in comparison to the distal segment. Although the number of arterial reconstructive procedures has been definitively declined, as was seen in sympathectomy surgery. It is difficult to predict accurately what kind of factors are affecting or contributing to the change in concept in Buerger's disease as well as the course of treatment, it is suggested that the environmental factors may playing a major role for the modification of disease process.
血栓闭塞性脉管炎最初由利奥·布尔格于1908年描述为血栓性闭塞性脉管炎，在我国一直被视为最难治疗的血管炎综合征之一。这种病变常见于有大量吸烟史的年轻男性群体。在日本的临床实践中，血栓闭塞性脉管炎屡见不鲜；然而，值得注意的是，在患者数量、临床表现以及治疗过程，尤其是手术治疗方面，已经出现了某些明确的变化。首先，门诊就诊以及住院的患者数量急剧下降。其次，血栓闭塞性脉管炎的手术治疗数量也有所减少。过去约占入院患者数量15%至20%的交感神经切除术，主要是腰交感神经切除术，实际上已不再施行，主要转变为使用前列腺素的药物治疗。药物性交感神经切除术的可靠性是促成治疗方式转变的另一个原因。我们还感觉疾病本身的严重程度也发生了变化，换句话说，我们现在不常看到病情非常严重的患者。就手术而言，治疗血栓闭塞性脉管炎晚期病变的重要方式主要局限于多节段闭塞的小动脉。因此，手术重建操作技术难度大，长期通畅率被认为较低。就我们的经验而言，值得注意的是，旁路手术最常见于膝关节分叉以下节段；换句话说，外周远端型旁路手术最普遍，其次是膝关节以上节段。股部区域的重建手术最少见。另一方面，与远端节段相比，旁路移植的近端节段通畅率更高。尽管动脉重建手术的数量确实像交感神经切除术那样有所下降。很难准确预测哪些因素正在影响或促成血栓闭塞性脉管炎治疗观念及治疗过程的变化，有人认为环境因素可能在疾病进程的改变中起主要作用。
