Seifert Sven, Sebesta Pavel, Klenske Marian, Esche Mirko
Klinik für Thorax-, Gefäß- und endovaskuläre Chirurgie, Klinikum Chemnitz gGmbH, Deutschland.
Zentralbl Chir. 2017 Feb;142(1):104-112. doi: 10.1055/s-0042-121611. Epub 2017 Mar 16.
Thoracic outlet syndrome (TOS) is one of the most extensively discussed diagnoses. There is neither a clear and homogenous clinical presentation nor an accepted definition. The term describes a complex of symptoms and complaints caused by the compression of nerves and vascular structures at one of the three defined constrictions of the upper thoracic aperture. Based on a comprehensive literature review, this article presents the etiology, epidemiology and clinical diagnostics as well as the possibilities and outcomes of surgical treatment. The thoracic outlet syndrome is currently subdivided into three main forms: vascular TOS (vasTOS) including arterial TOS (aTOS) and venous TOS (vTOS), neurogenic TOS (nTOS), which is further subdivided into typical (nTOS) and atypical TOS (disTOS), and a mixed form of nTOS and vasTOS (nvasTOS). The diagnosis is complex and difficult since the disTOS group comprises over 90 % of all patients. In addition to conservative treatment attempts, nTOS may be treated by surgical procedures focusing on the decompression of neurovascular structures. A significant improvement after surgery was found in up to 92 % of cases. The most common access sites are supraclavicular and transaxillary. 50 to 80 % of patients benefit from surgery in the long run. The rates of vascular or neurological complications reported by specialised centres are 0 to 2 %; minor complications such as pneumothorax, bleeding and lymphatic fistula are reported in up to 25 % of cases. Most patients suffering from any form of TOS benefit from surgical treatment. Duration of symptoms, socioeconomic factors and, most notably, stringent diagnostic workup and an adequate operative procedure performed by an experienced centre are crucial to success.
胸廓出口综合征（TOS）是讨论最为广泛的诊断之一。其临床表现既不清晰也不统一，定义也未得到广泛认可。该术语描述了由胸廓上口三个特定狭窄部位之一的神经和血管结构受压所引起的一系列症状和不适。基于全面的文献综述，本文介绍了胸廓出口综合征的病因、流行病学、临床诊断以及手术治疗的可能性和结果。胸廓出口综合征目前主要分为三种类型：血管性TOS（vasTOS），包括动脉性TOS（aTOS）和静脉性TOS（vTOS）；神经源性TOS（nTOS），进一步细分为典型（nTOS）和非典型TOS（disTOS）；以及nTOS和vasTOS的混合形式（nvasTOS）。由于非典型TOS组占所有患者的90%以上，因此诊断复杂且困难。除了尝试保守治疗外，神经源性TOS可通过针对神经血管结构减压的手术进行治疗。高达92%的病例术后有显著改善。最常见的手术入路部位是锁骨上和经腋窝。从长远来看，50%至80%的患者从手术中获益。专业中心报告的血管或神经并发症发生率为0%至2%；高达25%的病例报告有气胸、出血和淋巴瘘等轻微并发症。大多数患有任何形式胸廓出口综合征的患者都能从手术治疗中获益。症状持续时间、社会经济因素，最显著的是严格的诊断检查以及由经验丰富的中心进行的适当手术操作对成功至关重要。
