Urschel H C
Department of Thoracic and Cardiovascular Surgery, University of Texas Southwestern Medical School, Dallas, USA.
Semin Thorac Cardiovasc Surg. 1996 Apr;8(2):214-20.
The diagnosis and management of thoracic outlet syndromes is based on the surgical management of more than 3,000 patients, 800 of which have had recurrent thoracic outlet syndromes. Accurate diagnosis for peripheral nerve compression is based on measurement of the ulnar and median nerve conduction velocities across the thoracic outlet. For sympathetic maintained pain syndrome or causalgia, a stellate ganglion block is helpful. Arteriography and venography are critical to show vascular compression. Conservative management is successful in most cases (70%) initially. For arterial reconstruction, the supraclavicular-infraclavicular approach is recommended. For the Paget-Schroetter syndrome (effort thrombosis of the axillary subclavian vein), prompt thrombolysis followed by transaxillary first rib resection is mandatory. No long-term anticoagulants are necessary. For hyperhidrosis, causalgia, sympathetic maintained pain syndrome or reflex sympathetic dystrophy, transaxillary dorsal sympathectomy with first rib resection or thoracoscopy is the preferred management when conservative therapy fails. For recurrent thoracic outlet syndrome and sympathetic maintained pain syndrome, a high thoracoplasty posterior approach is preferable with neurolysis of the nerve roots and brachial plexus as well as a dorsal sympathectomy. The technique of transaxillary first rib resection with or without dorsal sympathectomy is presented. The use of the thoracoscope expedites the procedure and improves the teaching capability.
胸廓出口综合征的诊断与治疗基于对3000余例患者的外科治疗经验，其中800例患有复发性胸廓出口综合征。外周神经受压的准确诊断基于测量胸廓出口处尺神经和正中神经的传导速度。对于交感神经维持性疼痛综合征或灼性神经痛，星状神经节阻滞是有效的。血管造影和静脉造影对于显示血管受压至关重要。大多数情况下（70%），初始保守治疗是成功的。对于动脉重建，建议采用锁骨上-锁骨下途径。对于佩吉特-施罗特综合征（腋-锁骨下静脉用力性血栓形成），必须立即进行溶栓治疗，随后行经腋第一肋切除术，无需长期抗凝治疗。对于多汗症、灼性神经痛、交感神经维持性疼痛综合征或反射性交感神经营养不良，当保守治疗失败时，行经腋背侧交感神经切除术联合第一肋切除术或胸腔镜手术是首选治疗方法。对于复发性胸廓出口综合征和交感神经维持性疼痛综合征，高位胸廓成形术后路手术是较好的选择，同时进行神经根和臂丛神经松解以及背侧交感神经切除术。介绍了行经腋第一肋切除术联合或不联合背侧交感神经切除术的技术。胸腔镜的使用加快了手术进程并提高了教学效果。
