腰交感神经阻滞治疗盘源性下腰痛的疗效观察

目的:察CT引导下腰交感神经阻滞治疗盘源性下腰痛(Discogenin low back pain)的疗效.方法:择盘源性下腰痛患者40例,患者在CT引导下行腰交感神经节阻滞,记录术前、术后VAS评分.结果:肢术后VAS评分显著下降.结论:T引导下腰交感神经阻滞能有效缓解盘源性下腰痛的症状.     

连续腰交感神经阻滞治疗盘源性下腰痛的疗效观察

目的:观察CT引导下连续腰交感神经阻滞治疗盘源性下腰痛(Discogenin low back pain)的疗效.方法:选择盘源性下腰痛患者32例,患者在CT引导下行连续腰交感神经节阻滞.结果:患肢术后疼痛、发凉异常感觉有效率93.7%,治愈率75%.结论:CT引导下连续腰交感神经阻滞能有效缓解盘源性下腰痛的症状.     

腹膜后腹腔镜下腰交感神经节切除术三例

自 2 0 0 3年 4月至 2 0 0 4年 4月我院对 3例血栓闭塞性脉管炎 (TAO)施行了腹膜后腹腔镜下腰交感神经节切除术 ,现报告如下。临床资料1 一般资料 :3例患者均为男性 ,右下肢 2例 ,双下肢1例 ;年龄 1 9～ 34岁 ,平均 2 7 7岁 ;有吸烟史 3～ 1 2年 ,平均7 7年 ,病程 6～ 2 8个     

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1923年，Royle在治疗1例大脑皮质受伤的病人时。采用切除其一侧腰交感神经干的方法来缓解下肢肌痉挛术后不但肌痉挛得到缓解，同时还发现右腿毛细血管扩张，皮温升高。这就是首例腰交感神经切除术。腰交感神经切除术已有80年的历史，在血管外科技术不太成熟的当时，曾经是治疗下肢缺血性疾病的常规方法。开放性腰交感神经     

改良L2交感神经节毁损术治疗晚期癌性腰腿痛

晚期癌性腰腿痛患者疼痛剧烈,给患者带来极大的痛苦和生活质量的下降,镇痛药物难以达到预期效果。交感神经切除术被认为是缓解神经痛最有效的治疗手段之一,化学性腰交感切除术（CLS）可取得与手术切除腰交感神经相类似的结果,但传统的CLS需行多节毁损,在腰交感神经节中L2的作用最为重要,单毁损L2交感神经节便可达到理想疗效。     

腰交感神经节射频热凝毁损术的临床应用

目的探讨数字减影(ADS)引导下腰交感神经节射频消融术的疗效及安全性。方法 42例腰腿部血管性或交感性反射性疼痛病人,随机分为两组:均在ADS引导下,穿剌到位Ⅰ组(22例)行电剌激及局麻药阻滞试验确认后行射频热凝毁损,温度80℃,时间75s,两个周期,Ⅱ组(20例)行局麻药阻滞试验后以1%利多卡因10ml、维生素B12针0.5mg注射阻滞。结果Ⅰ组和Ⅱ组治疗后,下肢变暖者为94.7%和72.2%(P0.01)有极显著差异;VAS评分治疗后7d3.3±1.2和3.2±1.1分(P0.05)无显著性差异;3个月、6个月时有显著性差异(P0.05);显效、有效、部分有效均有显著性差异(P0.05),总有效率91.1%和80.0%有显著差异(P0.05)。结论腰交感神经节射频热凝毁损可有效长时间阻断腰交感性神经功能达到持续血管扩张,改善组织血液和营养供应、消除异感、减轻疼痛,是治疗腰腿部血管性或交感性反射性疼痛的安全有效、创伤小的微创治疗方法。     

血栓闭塞性脉管炎外科与腔内治疗疗效研究

目的 探讨外科与腔内治疗对下肢动脉血栓闭塞性脉管炎（thromboangiitis obliterans,TAO）的作用,为TAO的综合治疗提供循证医学依据。方法 回顾性分析2006年4月至2015年4月间,哈尔滨医科大学附属第一医院采用外科或腔内治疗下肢动脉TAO的202例病人的临床资料。根据踝肱指数（ABI）,Rutherford分级等指标评价各种手术方案的疗效。结果 Rutherford分级（R值）评价：术后1个月,行经皮腔内血管成型术（PTA）组、腰交感神经节切除组、序贯法内膜剥脱组、腰交感神经结节切除+序贯法内膜剥脱组病人与术前比较R值均降低（P＜0.05）;术后6个月,腰交感神经节切除组、序贯法内膜剥脱组、腰交感神经节切除+序贯法内膜剥脱组R值降低（P＜0.05）;术后12个月,序贯法内膜剥脱组、腰交感神经节切除+序贯法内膜剥脱组R值降低（P＜0.05）。ABI指标：术后1周,4组病人与术前比较ABI值均升高（P＜0.05）;术后6个月,腰交感神经节切除+序贯法内膜剥脱组ABI值升高（P<0.05）;术后12个月,序贯法内膜剥脱组、腰交感神经节切除+序贯法内膜剥脱组ABI值升高（P<0.05）。结论 单纯PTA和腰交感神经节切除术使膝下远端动脉闭塞的TAO病人术后短期内获益明显。单纯序贯法内膜剥脱术或联合腰交感神经节切除术是一种治疗下肢动脉TAO明确有效的外科治疗方法。     

交感神经节切除术治疗雷诺病

目的 研究胸腔镜交感神经节切除术和,或化学性腰交感神经节切除术治疗雷诺病。方法 本组5例,男性1例,女性4例,年龄30．65岁(平均45．3岁)。雷诺现象只表现在手部1例,1例只表现在足部并伴有1足趾坏疽,其余3例四肢均受影响。对有手部症状行胸腔镜胸交感神经节切除术,而对有足部症状行化学性腰L2-3,交感神经节切除术。结果 5例随访12—48个月,平均24个月。有手部症状均于术后立即得到改善,双手温暖,效果满意。但6个月后2例原有症状均复发。化学性腰交感神经节切除术后,双足温暖,一直未复发,效果满意。结论 胸腔镜胸交感神经节切除术治疗手部雷诺病可获得短期缓解,但效果不甚理想。化学性腰交感神经节切除对足部雷诺病有显效果．症状消失。效果很好。     

腰交感神经节射频消融治疗中脉搏血氧饱和度监测的应用

临床上监测患肢皮肤温度的变化可作为腰交感神经节阻滞效果的主要标准。我们在腰交感神经节射频消融(radiofrequency ablation,RFA)治疗中观察患肢足趾脉搏血氧饱和度(SpO2)脉搏波幅和足背皮肤温度的变化,以探讨应用SpO2仪监测和评价交感神经节阻滞疗效的可行性。     

动脉内膜剥脱联合腰交感神经节切除术治疗下肢血栓闭塞性脉管炎的回顾性分析

目的探讨动脉内膜剥脱术联合腰交感神经节切除术对下肢血栓闭塞性脉管炎(TAO的疗效。方法回顾性分析2010年7月至2018年7月哈尔滨医科大学附属第一医院行动脉内膜剥脱联合腰交感神经节切除术的108例(114条肢体)TAO患者的临床资料,比较踝肱指数(ABI)、保肢率、Rutherford分级和视觉模拟评分(VAS)以评价手术疗效。结果患者术后1周累计保肢率为100%,术后6个月累计保肢率为98.2%,术后12个月累计保肢率为95.6%。和术前相比,患者术后1周、6、12个月ABI均明显升高(P0.05),Rutherford分级和VAS疼痛评分均明显降低(P0.05)。结论动脉内膜剥脱术联合腰交感神经节切除术对TAO患者具有良好的效果。     

85例感染性心内膜炎的临床诊断与外科治疗

【摘要】 目的 总结感染性心内膜炎(IE)的临床诊断、外科手术和围手术期处理的经验。方法 回顾性分析2004年9月至2012年12月在我院接受手术治疗的85例IE患者的临床资料。其中男52例,女33例,年龄15~71岁,平均年龄35±16.2岁。85例患者中,12例患者接受了急诊手术治疗;71例患者术前进行了血培养检查,其中阳性18例(阳性率25.4%);超声心动图检查发现赘生物患者73例。所有患者均经外科手术清除感染病灶,纠治瓣膜病变及心脏畸形。结果 全组无手术死亡,均痊愈出院。随防72例,随防时间2~95月,平均53.3±26月,1例因自行停服抗凝药导致机械瓣栓塞死于出院后半年。其余71例术后感染性心内膜炎均未复发。术后心功能恢复至I级61例,心功能恢复至II级24例。结论 早期诊断、适时手术,彻底清除感染病灶,和正确使用抗生素是治疗感染心内膜的重要措施。     

Thoracic and lumbar sympathetic ganglion block for post herpetic neuralgia]

Of 2,667 patients with herpes zoster who visited our hospital between January 1972 and March 1989, 136 patients whose treatments were started after more than 6 months following the onset were subjects of the present study. Thus we performed a retrospective study of the therapeutic effects of sympathetic ganglion block (using alcohol) on postherpetic neuralgia left untreated for more than 6 months after the onset. After more than 1 year following the onset, the disease was nearly or completely cured in 9 of 37 patients (24%) treated with sympathetic ganglion block with alcohol and in 6 of 34 (17.6%) without the treatment. Thus the patients who underwent sympathetic ganglion block with alcohol tended to show better results. The above findings suggest that, in patients with postherpetic neuralgia in whom the initiation of treatment was delayed, treatment mainly consisting of thoracic or lumbar sympathetic ganglion block using alcohol in combination with antidepressants and antianxiety drugs can greatly improve patients' activities of daily life and that, at present, this method is most effective in relieving postherpetic neuralgia.     

Comparison of lower extremity cutaneous temperature changes in patients receiving lumbar sympathetic ganglion blocks versus epidural anesthesia

STUDY OBJECTIVE: To investigate if paravertebral lumbar sympathetic ganglion block and lumbar epidural anesthesia result in comparable cutaneous temperature changes in the lower extremity. DESIGN: Nonrandomized comparison study. SETTING: Operating rooms and pain clinic procedure rooms in a tertiary care hospital. PATIENTS AND INTERVENTIONS: 18 patients undergoing lumbar sympathetic ganglion blocks for the diagnosis and/or treatment of chronic pain, and 13 patients undergoing lumbar epidural anesthesia for radical prostatectomy. MEASUREMENTS: Cutaneous temperatures were measured over the great toe, calf, and thigh in all patients. Mean maximum temperature (Tmax), rate of change of skin temperature (from 5% to 95% of maximum temperature change), and mean time to 1 degrees C increase, and 50% and 95% of maximum temperature change for each group were compared. Temperature changes for the epidural and lumbar sympathetic block patients were compared. MAIN RESULTS: Epidural and lumbar sympathetic block resulted in similar Tmax (34.1 +/- 0.2 and 33.8 +/- 0.9 degrees C, respectively, mean +/- SEM; p = 0.18) and rate of temperature change (0.64 +/- 0.09 and 0.49 +/- 0.07 degrees C/min; p = 0.2) in the great toe. The onset of cutaneous temperature change after lumbar sympathetic block was slower than after epidural anesthesia (1 degrees C increase: 17 and 11 min, respectively, 50% of Tmax: 25 and 17 min, respectively, and 95% of Tmax: 40 and 31 min, respectively; p < 0.05 for each). CONCLUSIONS: The similar rate and magnitude of cutaneous temperature change in the distal lower extremity suggests the degree of sympathetic blockade is similar with lumbar sympathetic blockade and epidural anesthesia. Either technique should provide adequate sympathectomy for treating sympathetically maintained pain once the diagnosis has been confirmed using selective sympathetic blockade.     

腹腔镜脾切除加贲门食管周围血管离断术38例体会

【摘要】〓目的〓探讨腹腔镜脾切除加贲门食管周围血管离断术的疗效以及术后并发症的预防与处理。方法〓回顾性分析2010年1月~2014年3月应用腹腔镜脾切除加贲门食管周围血管离断术治疗的38例肝炎后肝硬化伴门静脉高压症病例的临床资料。结果〓所有病例均成功完成手术。手术时间238.42±75.25 min,术中出血量200.53±90.81 mL,总住院时间22.71±7.19 d,术后住院时间12.18±4.49 d,术后胃肠动力恢复时间3.45±0.89 d。手术前后肝功能结果无明显差异,而PLT术后明显升高(48.2±19.7 vs. 术前227.5±80.5,P<0.001)。随访过程中有6例发生再出血,3例发生肝性脑病,12例发生门静脉血栓,1例胰尾脓肿均经保守治疗后好转。结论〓腹腔镜脾切除加贲门食管周围血管离断术是一种安全,有效,且创伤小的门静脉高压症治疗手段。     

经皮椎间孔镜技术在复发性腰椎间盘突出症治疗中的应用

目的：探讨经皮椎间孔镜技术治疗复发性腰椎间盘突出症（recurrent lumbar disc hernia?tion, RLDH）的方法与疗效。方法回顾性分析2010年7月至2015年7月于我院应用经皮椎间孔镜技术治疗并获得随访的56例腰椎间盘突出症复发患者的临床资料。比较本组患者手术前后的直腿抬高角度、疼痛视觉模拟量表（visual analogue scale, VAS）评分、日本骨科协会（Japanese Orthopaedic Association, JOA）评估治疗分数,并采用Macnab标准评估疗效。结果本组患者手术时间为40~150 min,平均75 min;术中出血量为5~25 ml,平均10 ml;住院时间为4~14 d,平均7 d。术前患侧直腿抬高角度为（28.41±6.53）°,术后为（62.21±5.73）°;术前VAS评分为（8.04±1.12）分,术后为（2.42±1.38）分;术前JOA评分为（11.50±2.80）分,末次随访为（25.30±3.70）分。以上指标在手术前后数据的比较上,差异均具有统计学意义。所有患者均获随访,随访时间为3～60个月,平均28个月。根据Macnab标准进行评估：优28例,良19例,可6例,差3例,优良率为83.93%。结论对有合适手术适应证的RLDH患者,使用经皮椎间孔镜技术治疗具有不破坏腰椎稳定性、手术时间短、恢复快、术后并发症少等明显优势,治疗效果良好。     

Surgical sympathectomy for reflex sympathetic dystrophy syndromes

PURPOSE: The purpose of this study was the assessment of the efficacy of thoracoscopic cervicodorsal and open lumbar sympathectomy for the reduction of pain severity and disability associated with reflex sympathetic dystrophy (RSD). METHODS: From 1992 to 2000, 73 patients with RSD underwent 46 video-assisted thoracoscopic (first to fourth thoracic ganglion) or 37 surgical lumbar (first to fourth lumbar ganglion) sympathetic chain resections. The patients were referred from multidisciplinary pain clinics with documented sympathetically maintained pain syndrome on the basis of reproducible more than 50% reduction in pain severity score (0, no pain; 10, most severe pain imaginable) for more than 2 days after sympathetic block therapy. The mean duration of the RSD symptoms before sympathectomy was 26 plus minus 14 months (range, 6 to 100 months). Postoperative pain severity score, limb disability, and overall patient satisfaction were assessed by an independent third-party observer at a mean follow-up period of 30 months. RESULTS: No operative mortality or serious morbidity (Horner's syndrome, bleeding that needed transfusion, wound infection) occurred. Transient (<3-month) postprocedural sympathalgia developed in one third of the patients for cervicodorsal sympathectomy and 20% of the patients for lumbar sympathectomy and was treated effectively with trigger point/proximal ganglion block therapy or transcutaneous electrical nerve stimulation. At 3 months after sympathectomy, 10% of the patients had conditions that were judged treatment failures with no reduction in pain severity or limb disability. The remaining patients testified to more than 50% pain reduction, with pain severity scores decreasing from a mean of 8.7 before surgery to 3.4 after sympathectomy. At 1 year, one quarter of the patients had continued significant pain relief (pain severity score, <3) and an additional 50% of the patients indicated continued but reduced pain severity and an increase in daily/work activities. Overall, patient satisfaction (willingness to have procedure again, benefit from sympathectomy) was 77% and was not significantly influenced by patient age, RSD duration/stage, or extremity involvement (lumbar, 84%; cervicodorsal, 72%). CONCLUSION: Patients with RSD with a confirmed sympathetically maintained pain syndrome can realize long-term benefit from surgical sympathectomy. Procedural efficacy was similar for both upper limb and lower limb RSD syndromes, although the level of pain reduction did deteriorate with time. After sympathectomy, the patients with RSD had a low incidence rate (7%) of "new" complex regional pain or disabling compensatory sweating syndromes.     

Lumbar sympathetic blocks speed early and second stage induced labor in nulliparous women

BACKGROUND: Rapid cervical dilation reportedly accompanies lumbar sympathetic blockade, whereas epidural analgesia is associated with slow labor. The authors compared the effects of initial lumbar sympathetic block with those of epidural analgesia on labor speed and delivery mode in this pilot study. METHODS: At a hospital not practicing active labor management, full-term nulliparous patients whose labors were induced randomly received initial lumbar sympathetic block or epidural analgesia. The latter patients received 10 ml bupivacaine, 0.125%; 50 microg fentanyl; and 100 microg epinephrine epidurally and sham lumbar sympathetic blocks. Patients to have lumbar sympathetic blocks received 10 ml bupivacaine, 0.5%; 25 microg fentanyl; and 50 microg epinephrine bilaterally and epidural catheters. Subsequently, all patients received epidural analgesia. RESULTS: Cervical dilation occurred more quickly (57 vs. 120 min/cm cervical dilation; P = 0.05) during the first 2 h of analgesia in patients having lumbar sympathetic blocks (n = 17) than in patients having epidurals (n = 19). The second stage of labor was briefer in patients having lumbar sympathetic blocks than in those having epidurals (105 vs. 270 min; P < 0.05). Nine patients having lumbar sympathetic block and seven having epidurals delivered spontaneously, whereas seven patients having lumbar sympathetic block and seven having epidurals had instrument-assisted vaginal deliveries. Cesarean delivery for fetal bradycardia occurred in one patient having lumbar sympathetic block. Cesarean delivery for dystocia occurred in five patients having epidurals compared with no patient having lumbar sympathetic block (P = not significant). Visual analog pain scores differed only at 60 min after block. CONCLUSIONS: Nulliparous parturients having induced labor and receiving initial lumbar sympathetic blocks had faster cervical dilation during the first 2 h of analgesia, shorter second-stage labors, and a trend toward a lower dystocia cesarean delivery rate than did patients having epidural analgesia. The effects of lumbar sympathetic block on labor need to be determined in other patient groups. These results may help define the tocodynamic effects of regional labor analgesia.     

显微外科微创技术与传统手术治疗腰椎间盘突出症的比较观察

目的 探讨与传统椎间盘摘除术相比,显微外科微创技术治疗腰椎间盘突出症的手术疗效和优缺点.方法 回顾性分析2008年1月至2010年1月因腰椎间盘突出症采用显微腰椎间盘摘除术(40例)和传统后路椎板开窗术(48例)病例的手术时间、术中出血、术后住院天数和手术疗效.突出间隙:L3～L4突出12例,L4～L5突出46例,L5～S1突出30例.常规术式术前腰椎JOA评分8～19分,平均12.2分.显微外科术式术前腰椎JOA评分7～19分,平均12.7分.结果 2例常规术式术中出现硬脊膜破裂,予缝合修复.所有病例经10～34个月(平均18个月)随访,无神经根损伤、马尾神经损伤及感染等并发症.常规术式术后10个月JOA评分(24.0±2.6)分,优良率为87.5%.显微外科术式术后10个月JOA评分(24.2±2.8)分,优良率为90%.结论 显微技术下单节段腰椎间盘突出症与传统后路椎板开窗手术疗效相近,具有创伤小、术后住院时间短、手术效果确切等优点,同时进一步减少了术中出血量.是一种治疗单节段腰椎间盘突出症的理想的微创术式.

Abstract：

Objective To discuss the surgical outcome of fenestration assistant by microscopy for single-level lumbar disc protrusion (LDH), compared with tradition laminotomy and discectomy. Methods From January 2008 to January 2010, forty-eight patients underwent traditional open discectomy and 40 underwent microscopy surgery. The lumbar disc protrusion involved L3- L4 level in 12 cases, L4-L5 level in 46 cases, and L5-S1 level in 30 cases; preoperative JOA score was 8-19 points (average 12.9 points) for traditional open discectomy patients and 7-19 points (average 12.7 points) for microscopy surgery patients. Results Cauda equina injury was occurred and repaired in 2 cases in traditional surgery group. The follow-up period was 10-34 months (average 18 months) for all patients. No complications such as wrong orientation, nerve root injury, and infection occurred. The JOA score 10 months after operation was (24.0 ± 2.6) for traditional surgery patients with 87.5% success rate and (24.2 ± 2.8) for microscopy surgery patients with 90% success rate. Conclusion Two methods have similar clinical outcomes, but microscopy assistant fenestration for LDH has advantages of minimal invasion, shorter operative time, shorter length of hospital stay and less intraoperative blood loss. It is one of ideal minimally invasive operations for single-level lumbar disc protrusion.     

经Wiltse入路行腰椎翻修手术的临床疗效观察

目的探讨经Wiltse入路行腰椎翻修手术的临床疗效。方法回顾性分析2012年1月至2018年8月于我院行腰椎翻修手术病人59例,按手术入路方式分为两组,其中Wiltse入路组31例,传统入路组28例。收集并比较两组病人的手术时间、术后住院时间、术中出血量、引流量、术后并发症情况、疼痛视觉模拟量表(visual analog scale, VAS)评分、健康调查简表(the MOS 36-item short-form health survey, SF-36)评分、Oswestry功能障碍指数(Oswestry disability index, ODI)。结果所有病人均顺利完成手术。随访时间为12~40个月,平均25.5个月。Wiltse入路组病人的手术时间、术中出血量、术后引流量、术后住院时间分别为(3.51±0.36)h、(372.58±90.81)ml、(226.07±116.73)ml、(7.68±1.83)d;传统入路组分别为(4.20±0.82)h、(392.50±142.38)ml、(296.92±106.01)ml、(8.29±2.17)d;Wiltse入路组的手术时间和术后引流量均明显小于传统入路组,差异均有统计学意义(P均<0.05)。59例病人术后1个月、1年随访时的腰椎VAS评分、ODI、SF-36评分均较术前显著改善;两组间比较,Wiltse入路组术后1个月的VAS评分和ODI显著优于传统入路组;上述指标比较,差异均有统计学意义(P均<0.05),其他指标的差异均无统计学意义(P均>0.05)。两组病人均未出现严重并发症。结论与传统入路相比,Wiltse入路行腰椎翻修手术具有手术时间短、术后引流量少、软组织损伤小、腰部功能恢复快等优点,临床疗效满意。     

Lumbar Sympathetic Blocks Speed Early and Second Stage Induced Labor in Nulliparous Women

Background: Rapid cervical dilation reportedly accompanies lumbar sympathetic blockade, whereas epidural analgesia is associated with slow labor. The authors compared the effects of initial lumbar sympathetic block with those of epidural analgesia on labor speed and delivery mode in this pilot study.

Methods: At a hospital not practicing active labor management, full-term nulliparous patients whose labors were induced randomly received initial lumbar sympathetic block or epidural analgesia. The latter patients received 10 ml bupivacaine, 0.125%; 50 [micro sign]g fentanyl; and 100 [micro sign]g epinephrine epidurally and sham lumbar sympathetic blocks. Patients to have lumbar sympathetic blocks received 10 ml bupivacaine, 0.5%; 25 [micro sign]g fentanyl; and 50 [micro sign]g epinephrine bilaterally and epidural catheters. Subsequently, all patients received epidural analgesia.

Results: Cervical dilation occurred more quickly (57 vs. 120 min/cm cervical dilation; P = 0.05) during the first 2 h of analgesia in patients having lumbar sympathetic blocks (n = 17) than in patients having epidurals (n = 19). The second stage of labor was briefer in patients having lumbar sympathetic blocks than in those having epidurals (105 vs. 270 min; P < 0.05). Nine patients having lumbar sympathetic block and seven having epidurals delivered spontaneously, whereas seven patients having lumbar sympathetic block and seven having epidurals had instrument-assisted vaginal deliveries. Cesarean delivery for fetal bradycardia occurred in one patient having lumbar sympathetic block. Cesarean delivery for dystocia occurred in five patients having epidurals compared with no patient having lumbar sympathetic block (P = not significant). Visual analog pain scores differed only at 60 min after block.