Jubbal Kevin T, Zavlin Dmitry, Harris Joshua D, Liberman Shari R, Echo Anthony
Loma Linda University, CA, USA.
Houston Methodist Hospital, TX, USA.
Hand (N Y). 2019 Sep;14(5):636-640. doi: 10.1177/1558944718760037. Epub 2018 Mar 5.
Thoracic outlet syndrome (TOS) is a complex entity resulting in neurogenic or vascular manifestations. A wide array of procedures has evolved, each with its own benefits and drawbacks. The authors hypothesized that treatment of TOS with first rib resection (FRR) may lead to increased complication rates. A retrospective case control study was performed on the basis of the National Surgical Quality Improvement Program database from 2005 to 2014. All cases involving the operative treatment of TOS were extracted. Primary outcomes included surgical and medical complications. Analyses were primarily stratified by FRR and secondarily by other procedure types. A total of 1853 patients met inclusion criteria. The most common procedures were FRR (64.0%), anterior scalenectomy with cervical rib resection (32.9%), brachial plexus decompression (27.2%), and anterior scalenectomy without cervical rib resection (AS, 8.9%). Factors associated with increased medical complications included American Society of Anesthesiologists (ASA) classification of 3 or greater and increased operative time. The presence or absence of FRR did not influence complication rates. FRR is not associated with an increased risk of medical or surgical complications. Medical complications are associated with increased ASA scores and longer operative time.
胸廓出口综合征（TOS）是一种复杂的病症，可导致神经源性或血管性表现。已经发展出了一系列的手术方法，每种方法都有其自身的优缺点。作者推测，采用第一肋切除术（FRR）治疗TOS可能会导致并发症发生率增加。基于2005年至2014年的国家外科质量改进计划数据库进行了一项回顾性病例对照研究。提取了所有涉及TOS手术治疗的病例。主要结局包括手术并发症和医疗并发症。分析主要按FRR分层，其次按其他手术类型分层。共有1853例患者符合纳入标准。最常见的手术方法是FRR（64.0%）、颈椎肋切除伴前斜角肌切除术（32.9%）、臂丛神经减压术（27.2%）和无颈椎肋切除的前斜角肌切除术（AS，8.9%）。与医疗并发症增加相关的因素包括美国麻醉医师协会（ASA）分级为3级或更高以及手术时间延长。是否进行FRR并不影响并发症发生率。FRR与医疗或手术并发症风险增加无关。医疗并发症与ASA评分增加和手术时间延长有关。
