腰交感神经射频热凝术与化学毁损术治疗下肢缺血性疾病的疗效对比

COMPARISON OF LUMBAR SYMPATHETIC NERVE RADIOFREQUENCY THERMOCOAGULATION AND CHEMICAL ABLATION IN THE TREATMENT OF ISCHEMIC DISEASE OF LOWER EXTREMITY

目的:随着腰交感神经化学毁损术在临床上的大量应用,其术后频发的并发症也引起了很大的关注。近来射频热凝技术的进步使腰交感神经射频热凝术得到了广泛应用,但是对于两者疗效与并发症发生率的对比研究尚且较少。本文通过与化学毁损术对比,评估腰交感神经射频热凝术治疗下肢缺血性疾病的疗效与并发症发生率。方法:选取2013年10月至2015年2月我院收治的40例下肢缺血性疾病病人,随机分为两组。均在CT引导下穿刺,到达目标位置后A组行腰交感神经射频热凝术治疗,B组行化学毁损术治疗。测量术前及术后下肢皮温、观察术后临床疗效及并发症发生情况。结果:40例病人在CT引导下均穿刺成功,治疗后疼痛缓解明显。两组治疗1周及1个月后组间视觉模拟评分法(visual analogue scale,VAS)评分及皮温升高均无统计学差异(P>0.05);术后并发症A组0例,B组20例中出现3例(15%),差异有统计学意义。结论:腰交感神经射频热凝术治疗下肢缺血性疾病可改善下肢组织血运及营养供给,较化学毁损术并发症少,是下肢缺血性疾病的有效治疗方法。

Objective： With the widespread clinical application of lumbar sympathectomy with chemical ablation, the complications have attracted much attention. Recent advances in radiofrequency thermocoagulation have led to widespread use of lumbar sympathetic radiofrequency thermocoagulation, but few studies reported the comparison of efficacy and complications about the two methods of lumbar sympathectomy with chemical ablation or radiofrequency thermocogulation. In our study, we evaluated the effects and the complications about the two methods for the treatment of ischemic disease of lower extremity. Methods： The subjects in this study included 40 patients with ischemic disease of lower extremity in Affiliated First Hospital of China Medical University from Oc- tober 2013 to February 2015. They were randomly assigned to two groups. After reaching the target position with the guidance of CT, patients in Group A were treated with lumbar sympathetic nerve radiofrequency thermocoagulation, whereas patients in Group B were treated with chemical ablation. We measured the lower limb skin temperature before and after the surgery, evaluated the clinical effects and the complications. Results： All the 40 patients were punctured successfully with the guidance of CT, and the pain was obviously relieved after treatment. There was no significant difference between the two groups in the VAS scores and the lower limb skin temperature of 1 week and 1 month after the surgery （P 〉 0.05）. No patients in Group A suffered the relative complication, but 3 patients （15%） in Group B did. There was significant difference between the two groups. Conclusion： The lumbar sympathetic nerve radiofrequency thennocoagulation can improve the blood circulation and the nutrient supply of lower limbs, and has fewer complications. It is an effective method to treat the ischemic disease of lower extremity.