Prêtre R, Spiliopoulos A, Mégevand R
Départment de Chirurgie, Hôpital Cantonal Universitaire, Geneva, Switzerland.
Surgery. 1989 Nov;106(5):856-60.
This retrospective study compares the results of two surgical procedures, a transaxillary and a transthoracic (that is, anterolateral thoracotomy) approach, in the treatment of the thoracic outlet syndrome by first rib resection. After transaxillary first rib removal (13 cases), initially our procedure of choice, 84% of conditions were improved, 8% were unchanged, and 8% were worse after 1 year. One permanent, disabling brachial plexus injury occurred after this operation. Transthoracic first rib resection (18 cases), presently our preferred technique, resulted in improvement in 87% of cases, with 13% of symptoms unchanged after 1 year. Although two female patients felt mild paresthesia of the mammary gland, no one has been made worse following this route. These two approaches have achieved similar results in the surgical management of this syndrome. Nevertheless, when first rib resection is indicated, our favored and recommended procedure is transthoracic, because this route appears less hazardous for brachial plexus damage.
这项回顾性研究比较了两种手术方法（经腋窝和经胸壁[即前外侧开胸术]）通过切除第一肋治疗胸廓出口综合征的结果。在最初我们选择的经腋窝切除第一肋手术（13例）后，1年后84%的病情得到改善，8%无变化，8%恶化。该手术后发生了1例永久性、致残性臂丛神经损伤。经胸壁切除第一肋手术（18例），目前是我们首选的技术，1年后87%的病例病情得到改善，13%症状无变化。虽然有两名女性患者感到乳腺轻度感觉异常，但经此手术路径无人病情恶化。这两种手术方法在该综合征的外科治疗中取得了相似的结果。然而，当需要切除第一肋时，我们更倾向和推荐的手术方法是经胸壁手术，因为此路径对臂丛神经损伤的风险似乎较小。
