Davies A H, Walton J, Stuart E, Morris P J
Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Headington, UK.
Br J Surg. 1991 Oct;78(10):1193-5. doi: 10.1002/bjs.1800781015.
There is some disagreement about whether the first rib should be excised in the presence of a cervical rib for the relief of the thoracic outlet compression syndrome (TOCS). Over a 14-year period (1975-1988) 58 patients have undergone surgery for TOCS. Forty-four patients (76 per cent) had vascular symptoms, 28 (48 per cent) with a neurological component; 11 (19 per cent) had only neurological symptoms. Thirty-six patients (62 per cent) had the first rib excised; 19 (33 per cent) had a cervical rib excised; two (3 per cent) had a division of fibrous bands; and one patient had a large transverse process resected. Follow-up details were available on 53 patients (91 per cent). Overall 38 (72 per cent) were cured of their symptoms, 11 (21 per cent) had a significant improvement, and four (8 per cent) showed no improvement. There was no significant difference between the results following excision of a cervical rib or of a first rib in terms of relief of symptoms. In patients with TOCS who have a cervical rib, excision of the cervical rib alone without excision of the first rib would appear to be an appropriate treatment.
对于在存在颈肋的情况下是否应切除第一肋以缓解胸廓出口综合征（TOCS），存在一些分歧。在14年期间（1975 - 1988年），58例患者接受了TOCS手术。44例患者（76%）有血管症状，28例（48%）伴有神经症状；11例（19%）仅有神经症状。36例患者（62%）切除了第一肋；19例（33%）切除了颈肋；2例（3%）进行了纤维带松解；1例患者切除了大的横突。53例患者（91%）有随访详情。总体而言，38例（72%）症状治愈，11例（21%）有显著改善，4例（8%）无改善。就症状缓解而言，切除颈肋或第一肋后的结果无显著差异。对于有颈肋的TOCS患者，仅切除颈肋而不切除第一肋似乎是一种合适的治疗方法。
