Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA.
Ann Surg. 2023 Sep 1;278(3):417-425. doi: 10.1097/SLA.0000000000005957. Epub 2023 Jun 19.
We aimed to report efficacy, safety, and health-related quality of life (HRQoL) outcomes of a multidisciplinary treatment approach including supraclavicular thoracic outlet decompression among patients with thoracic outlet syndrome (TOS).
TOS is a challenging condition where controversy remains in diagnosis and treatment, primarily given a lack of data exploring various treatment approaches and associated patient outcomes.
Patients who underwent unilateral, supraclavicular thoracic outlet decompression, or pectoralis minor tenotomy for neurogenic, venous, or arterial TOS were identified from a prospectively maintained database. Demography, use of preoperative botulinum toxin injection, and participation in multidisciplinary evaluation were measured. The primary endpoints were composite postoperative morbidity and symptomatic improvement compared with baseline.
Among 2869 patients evaluated (2007-2021), 1032 underwent surgery, including 864 (83.7%) supraclavicular decompressions and 168 (16.3%) isolated pectoralis minor tenotomies. Predominant TOS subtypes among surgical patients were neurogenic (75.4%) and venous TOS (23.4%). Most patients (92.9%) with nTOS underwent preoperative botulinum toxin injection; 56.3% reported symptomatic improvement. Before surgical consultation, few patients reported participation in physical therapy (10.9%). The median time from first evaluation to surgery was 136 days (interquartile range: 55, 258). Among 864 patients who underwent supraclavicular thoracic outlet decompression, complications occurred in 19.8%; the most common complication was chyle leak (8.3%). Four patients (0.4%) required revisional thoracic outlet decompression. At a median follow-up of 420 days (interquartile range: 150, 937) 93.3% reported symptomatic improvement.
Based on low composite morbidity, need for very few revisional operations, and high rates of symptomatic improvement, a multidisciplinary treatment approach including primarily supraclavicular thoracic outlet decompression is safe and effective for patients with TOS.
我们旨在报告包括锁骨上胸廓出口减压术在内的多学科治疗方法对胸廓出口综合征（TOS）患者的疗效、安全性和健康相关生活质量（HRQoL）结果。
TOS 是一种具有挑战性的疾病，在诊断和治疗方面仍存在争议，主要是因为缺乏探索各种治疗方法和相关患者结局的数据。
从一个前瞻性维护的数据库中确定了接受单侧锁骨上胸廓出口减压术或胸小肌切开术治疗神经源性、静脉性或动脉性 TOS 的患者。测量了人口统计学数据、术前肉毒毒素注射的使用情况以及多学科评估的参与情况。主要终点是与基线相比，术后复合发病率和症状改善情况。
在 2869 名接受评估的患者（2007-2021 年）中，有 1032 名患者接受了手术，其中 864 名（83.7%）接受了锁骨上减压术，168 名（16.3%）接受了孤立的胸小肌切开术。手术患者中主要 TOS 亚型为神经源性（75.4%）和静脉性 TOS（23.4%）。大多数 nTOS 患者（92.9%）接受了术前肉毒毒素注射；56.3%报告症状改善。在手术咨询之前，很少有患者报告参与物理治疗（10.9%）。从首次评估到手术的中位数时间为 136 天（四分位距：55，258）。在 864 名接受锁骨上胸廓出口减压术的患者中，发生并发症的患者有 19.8%；最常见的并发症是乳糜漏（8.3%）。有 4 名患者（0.4%）需要进行胸廓出口再减压术。在中位数为 420 天（四分位距：150，937）的随访中，93.3%的患者报告症状改善。
基于低复合发病率、很少需要再次手术以及高症状改善率，包括主要锁骨上胸廓出口减压术在内的多学科治疗方法对 TOS 患者是安全有效的。
