【摘要】 目的 :观察联合应用腰交感神经节切除对分期动静脉转流术治疗下肢三期血栓闭塞性脉管炎的血液动力学及临床疗效方面的影响。方法 :共行分期股浅动静脉转流术治疗下肢三期血栓闭塞性脉管炎 2 1例 (2 2肢 ) ,其中并行腰交感神经节切除组 13例 (13肢 ) ,未切除组 8例 (9肢 )。用彩色多普勒检测第一期术后吻合口周围的血液动力学变化并进行比较。结果 :两组病人术后吻合口近端动静脉血流量均增加 (P <0 0 1) ,并神经节切除组较未切除组增加量多 (P <0 0 5 ) ;吻合口远端动脉血流量术后均无明显变化 (P >0 0 5 ) ;吻合口远端静脉离心方向血流量切除组较未切除组多 (P <0 0 5 )。并神经节切除组肢体溃疡或坏疽创面平均愈合时间较未切除组短。皮温升高明显。结论 :此联合手术治疗下肢三期血栓闭塞性脉管炎能起协同作用 ,使缺血肢体获得更多动脉血 ,取得更好疗效。更多还原

【Abstract】 Objective:To observe the hemodynamic changes and clinical results of the patients sufferring from stage Ⅲ thromboangiitis obliterans treated by arteriovenous reversal with lumbar sympathectomy.Methods:21cases of stage Ⅲ thromboangiitis obliterans with a total of 22 lower extremities were treated by staged superficial femoral arteriovenous reversal,13(13 limbs)of them were treated with ipsilateral lumbar sympathectomy,8 cases (9 limbs) without sympathectomy.The hemodynamic changes around femoral arteriovenous fistulae were investigated with Color Doppler flow imaging 2 weeks after the first stage operation.Results:After operation,the flows through the arteries and veins proximal to anastomases increased significantly in the two groups ( P <0.01),but the former group increased more( P <0 05).The flows through the arteries distal to anastomases were not changed significantly in the two groups( P >0 05).The retrograde flow of the vein distal to anastomasis was more than that of the group without sympathectomy( P <0 05).In the group with sympathectomy,the ulcers or gangrenes healed more quickly,the temperatures of operated limbs grew more apparently.Conclusion:Staged arteriovenous reversal with ipsilateral lumbar sympathectomy is a good combination to treat the patients suffering from stage Ⅲ thromboangiitis obliterans.It can supply more nutrient flow to an ischemic lower extremity.更多还原