Urschel H C, Razzuk M A
Ann Thorac Surg. 1986 Nov;42(5):523-8. doi: 10.1016/s0003-4975(10)60574-7.
In 225 patients requiring reoperation for recurrent thoracic outlet syndrome, "pseudorecurrences" were noted in 43 patients not relieved of symptoms after the initial operation. Such recurrences were associated with technical errors at the initial operation including resection of the second rib instead of the first, resection of the first with a cervical rib left in place, or resection of a cervical rib with an abnormal first rib left. True recurrences occurred in 182 patients, 154 of whom had a substantial piece of rib remaining from the initial procedure. Indications for reoperation included persistent pain, ulnar nerve conduction velocity of 60 m/sec or less (normal, 72 to 82 m/sec), and failure of appropriate physical therapy. Reoperation involved neurolysis of the brachial plexus, decompression of the vessels, and dorsal sympathectomy performed through a posterior thoracoplasty incision. One hundred seventy-seven patients (79%) had improvement, 32 (14%) had moderate improvement, and 16 (7%) were either considered failures or had recurrent scarring.
在225例因复发性胸廓出口综合征需要再次手术的患者中，43例在初次手术后症状未缓解，出现了“假性复发”。这种复发与初次手术时的技术失误有关，包括切除第二肋而非第一肋、切除第一肋时保留颈肋、或切除颈肋时保留异常的第一肋。真正的复发发生在182例患者中，其中154例在初次手术时有大量肋骨残留。再次手术的指征包括持续疼痛、尺神经传导速度为60米/秒或更低（正常为72至82米/秒）以及适当的物理治疗无效。再次手术包括通过后胸廓成形术切口进行臂丛神经松解、血管减压和胸交感神经切除术。177例患者（79%）病情改善，32例（14%）有中度改善，16例（7%）被认为手术失败或出现复发性瘢痕形成。
