Roos D B
Acta Chir Belg. 1980 Sep-Oct;79(5):363-72.
After initial relief of severe thoracic outlet syndrome by transaxillary resection of the first rib, a few patients may gradually develop recurrent neurologic symptoms in the neck, shoulder, arm and hand caused by postoperative scar tissue entrapment of segments of the brachial plexus. Once they begin, these symptoms may relentlessly progress to the extent they become unresponsive to all forms of conservative management. Two distinct patterns of recurrent TOS, which may occur separately or simultaneously, have been identified. Clinical measures that have proved effective in establishing the diagnosis of these types, the surgical techniques developed to offer relief, and measures to help prevent recurrence are discussed in this paper. A series of 76 patients who underwent operation for disabling recurrent TOS is presented. The principals of the etiology, diagnosis and surgical treatment described have offered significant, if not total, relief of the severe symptoms. The operations which have proved to be the most effective, however, are high-risk, technically demanding procedures which should be performed only by surgeons with wide experience in the anatomy and surgery of the thoracic outlet region. Although these techniques may offer patients significant relief, prevention of the recurrent thoracic outlet syndrome is still the best cure.
在通过经腋路切除第一肋初步缓解严重胸廓出口综合征后，少数患者可能会逐渐出现颈部、肩部、手臂和手部反复出现的神经症状，这是由于术后瘢痕组织压迫臂丛神经节段所致。一旦出现这些症状，可能会持续进展，直至对所有形式的保守治疗均无反应。已确定了两种不同类型的复发性胸廓出口综合征，它们可能单独出现或同时出现。本文讨论了在诊断这些类型时已被证明有效的临床措施、为缓解症状而开发的手术技术以及有助于预防复发的措施。本文介绍了一组76例因复发性严重胸廓出口综合征而接受手术的患者。所描述的病因、诊断和手术治疗原则已显著缓解了严重症状，即便不是完全缓解。然而，已被证明最有效的手术是高风险、技术要求高的手术，应由在胸廓出口区域解剖和手术方面经验丰富的外科医生进行。尽管这些技术可能会为患者带来显著缓解，但预防复发性胸廓出口综合征仍是最佳治疗方法。
