1 Department of Vascular and Endovascular Surgery, Johns Hopkins Medical Institutes, Baltimore, MD, USA.
2 Johns Hopkins Surgery Center for Outcomes Research (JSCOR), Johns Hopkins School of Medicine, Baltimore, MD, USA.
Angiology. 2017 Jul;68(6):502-507. doi: 10.1177/0003319716677666. Epub 2016 Nov 14.
We evaluated the occurrence of thoracic outlet syndrome (TOS) and 30-day postoperative outcomes. Patients undergoing cervical/first rib resection surgery were identified in the American College of Surgeons National Surgical Quality Improvement Program database (2005-2013). Thoracic outlet syndrome types were then examined. Propensity score matching was performed to account for potential confounders; 1180 patients were explored during the study period, 1007 (85.3%) were of the neurogenic TOS (NTOS), 32 (2.7%) patients had arterial TOS (ATOS), and 141 (12.0%) patients had venous TOS (VTOS). Patients with ATOS were significantly older (median age [interquartile range, IQR]-NTOS: 34 [25-44], ATOS: 49.5 [42.5-57], VTOS: 34 [23-43]; P < .001). Median operating time was significantly longer for patients with ATOS. Median in-hospital stay was also longer for patients with ATOS (median length of in-hospital stay [LOS; IQR]-NTOS: 2 [1-4]; ATOS: 6 [3-7]; and VTOS: 5 [2-7] days; P < .001). Patients with VTOS showed twice longer LOS when compared to NTOS after matching. Presentation and treatment of TOS have been studied extensively at highly experienced centers.
我们评估了胸廓出口综合征(TOS)的发生和 30 天术后结果。在美国外科医师学院国家手术质量改进计划数据库(2005-2013 年)中确定了接受颈椎/第一肋切除术的患者。然后检查了 TOS 类型。为了考虑潜在的混杂因素,进行了倾向评分匹配;在研究期间共探讨了 1180 例患者,其中 1007 例(85.3%)为神经源性 TOS(NTOS),32 例(2.7%)为动脉性 TOS(ATOS),141 例(12.0%)为静脉性 TOS(VTOS)。ATOS 患者明显年龄较大(中位数年龄[四分位距 IQR]-NTOS:34[25-44],ATOS:49.5[42.5-57],VTOS:34[23-43];P<0.001)。ATOS 患者的手术时间中位数明显较长。ATOS 患者的住院时间中位数也较长(中位数住院时间[LOS;IQR]-NTOS:2[1-4];ATOS:6[3-7];VTOS:5[2-7]天;P<0.001)。匹配后,VTOS 患者的 LOS 比 NTOS 患者长两倍。在经验丰富的中心已经广泛研究了 TOS 的表现和治疗。