化学性腰交感神经切除术的临床应用

Chemical lumbar sympathectomy for the treatment of lower limb ischemia

目的总结化学性腰交感神经切除术 (CLS)的临床效果。方法按腰交感神经节阻滞的方法穿刺 2针后 ,经X线拍片定位证实穿刺针尖位于腰 2、3椎体前外侧后 ,分别注射 6 7%石碳酸(或无水酒精 ) 3～ 4ml后拔出穿刺针。结果 10年来共施行CLS 36例。其中血栓闭塞性脉管炎 10例 ,雷诺病 4例 ,动脉硬化性闭塞症 2 1例 ,多发性大动脉炎 1例。其中 16例平均踝肱指数 0 47。CLS后疼痛缓解者 2 9例 (81% ) ,患肢转暖者 2 7例 (75 % )。CLS术后踝肱比 0～ 1 3,平均 0 5 8,CLS前后无统计学差异 (P >0 0 5 )。CLS后下肢神经痛 3例 (8% )。随访 32例 ,随访时间 3个月至 9年 ,在随访的患者中 ,CLS后有效的 2 6例中 ,2 4例仍维持CLS时的效果 ,2例加重而截肢。结论CLS是一种操作简单 ,并发症少 。

ObjectiveTo evaluate the efficacy of chemical lumbar sympathectomy (CLS). MethodsNiddle puncture was made toward the lateral front of L2 and L3 vertebra in a way similar to lumbar sympathetic block and the position was verified by X-ray before 3～4?ml of 6.7% phenol or anhydrous alcohol was injected. Results 36 patients were treated by CLS in 10 years including 10 cases of Buerger's disease, 4 of Raynaud's disease, 21 cases of arteriosclerosis obliterans, and 1 of Takayasu's disease. Rest pain was relieved in 29 (81%) cases. Ankle-pressure-index increased from 0.47 to 0.58 (P>0.05). Neuralgia of the lower limb was complicated in 3 (8%)cases. 31 cases were followed up from 3 months to 9 years. 24 out of the 26 patients experincing immediate post-CLS relief remained asymptomatic, and 2 suffered symptom deterioration necessitating major amputation. ConclusionsCLS is a simple procedure with less complication offering an alternative for the treatment of lower limb ischemia.