Cinà C, Whiteacre L, Edwards R, Maggisano R
Sunnybrook Medical Centre, University of Toronto, Ontario, Canada.
Cardiovasc Surg. 1994 Aug;2(4):514-8.
Of a total of 225 patients with suspected thoracic outlet syndrome, 37 (16.4%) underwent surgery. Some eight patients required bilateral operations. One patient had a cervical rib and one a prominent C7 transverse process. A total of 45 limbs were operated on. Thirty-nine procedures were performed as combined scalenectomy and transaxillary first rib resection, four as two-stage scalenectomy and transaxillary first rib resection and two as simple scalenectomy alone. Follow-up from 6 to 60 (mean 17) months was available for 39 operations. A two-tier assessment method was used to improve the accuracy of the results of surgery, including the patient's own evaluation of the benefit of operation communicated to an independent observer and the surgeon's clinical appraisal. Assessment of outcome by the physician was excellent in 54%, good in 28%, fair in 10% and 8% had recurrent symptoms. Similar results were achieved in the patients' subjective evaluation with approximately 50% reporting an excellent outcome, about 40% good and 10% fair. A poor result was not recorded in those who underwent combined scalenectomy and transaxillary first rib resection. A radical surgical approach combining scalenectomy and transaxillary first rib resection is advocated to minimize the recurrence rate and improve results.
在总共225例疑似胸廓出口综合征的患者中，37例（16.4%）接受了手术。约8例患者需要双侧手术。1例患者有颈肋，1例有C7横突突出。总共对45条肢体进行了手术。39例手术采用联合斜角肌切除术和经腋路第一肋切除术，4例采用两阶段斜角肌切除术和经腋路第一肋切除术，2例仅行单纯斜角肌切除术。39例手术的随访时间为6至60个月（平均17个月）。采用两级评估方法以提高手术结果的准确性，包括患者向独立观察者传达的对手术益处的自我评估以及外科医生的临床评估。医生对结果的评估为：优54%，良28%，中10%，8%有复发症状。患者主观评估也得到了类似结果，约50%报告结果为优，约40%为良及10%为中。接受联合斜角肌切除术和经腋路第一肋切除术的患者未出现差的结果。主张采用联合斜角肌切除术和经腋路第一肋切除术的根治性手术方法，以尽量降低复发率并改善结果。
