腹腔镜下腰交感神经节切除术治疗血栓闭塞性脉管炎

Laparoscopic lumbar gangliosympathectomy for thromboangiitis obliterans

目的评价CT引导下腰交感神经节阻滞试验在筛选适合腰交感神经节切除术(LGS)的血栓闭塞性脉管炎(TAO)患者中的价值,及腹膜后腹腔镜下腰交感神经节切除术(LLGS)治疗TAO的疗效。方法选择我院2003年4月～2010年1月期间,戒烟后症状不缓解的32例患者行腰交感神经节阻滞试验,采用LLGS治疗阻滞试验阳性的TAO患者17例。结果阻滞试验阳性的17例筛选进行LLGS,术后病理证实切除组织为神经节组织。手术后24小时内,17例患者共19条下肢皮温明显升高,均大于2℃。本组病例未发生严重并发症,仅1例术中出现皮下气肿,经对症处理3天后完全恢复正常;1例术后病理报告淋巴结,且症状无缓解,故再次行LLGS。17例患者住院时间(11±10)天,随访时间(24.5±32)个月,17例患者皮温正常,无静息痛,无肢端坏疽,并能耐受一般轻体力劳动。结论术前腰交感神经节阻滞试验有助于筛选适合进行LLGS的TAO患者;与传统LGS相比,LLGS具有术野清晰,定位准确,手术创伤小,恢复快,住院时间短等优势。

Objective To study the value of CT guided lumbar sympathetic ganglion block test in screening for lumbar sympathectomy for patients with thromboangiitis obliterans(TAO),and the efficacy of laparoscopic lumbar gangliosympathectomy(LLGS) in the treatment of TAO..Methods Between April 2003 and January 2010,32 symptomatic patients after smoking cessation received lumbar sympathetic block test.Patients who had positive results of lumbar sympathetic block test underwent LLGS.Results LLGS was performed on 17 patients with lumbar sympathetic block test positive and ganglion tissue removed was confirmed by pathology examination.Within 24 hours after surgery,temperature of the lower limbs significantly increased,.>2℃..No patient had serious complications,.and only one case was found subcutaneous emphysema intraoperatively and healed 3 days after procedure..One patient underwent secondary LLGS for error removal of lymph node.For all patients,hospital stay was 11±10 days and follow-up time was 24.5±32 months.They all had normal skin temperature,no rest pain,no gangrene and could do some light physical labor.Conclusion Preoperative lumbar sympathetic ganglion block technique is helpful to select appropriate candidates for LLGS.Compared with the traditional LGS,LLGS have advantages of clear operative field,accurate positioning,little surgical trauma,quick recovery,short hospital stay.