Cheng S W, Reilly L M, Nelken N A, Ellis W V, Stoney R J
Department of Surgery, Division of Vascular Surgery, University of California, San Francisco, CA 94143, USA.
Cardiovasc Surg. 1995 Dec;3(6):617-23; discussion: 624. doi: 10.1016/0967-2109(96)82859-6.
A total of 168 primary supraclavicular decompressions were performed on 146 patients with neurogenic thoracic outlet syndrome. This report compares the results of rib resection (supraclavicular anterior and middle scalenectomy and first rib resection) with rib-sparing (supraclavicular anterior and middle scalenectomy alone) operations. All patients with cervical ribs were excluded. In total, 125 rib resections and 43 rib-sparing procedures were performed between 1983 and 1992 by a single surgeon. The patients were otherwise comparable in symptoms and physical signs. During surgery there was a significantly higher proportion of pleural injury associated with rib resection (59%) than with rib-sparing (40%) procedures. The mean hospital stay was also prolonged by 1 day in patients undergoing rib resection (p = 0.005). There was no significant difference in early success between the two groups (83% for rib resection, 91% for rib sparing) and no difference in those resuming employment (52% and 63% respectively). Life-table analysis showed that the two groups have similar long-term results (69% and 76% at 2 years). The only important factor determining clinical outcome in primary supraclavicular thoracic outlet syndrome decompression was the duration of symptoms before operation. Some 83% of patients with symptoms less that 2 years had a successful result compared with only 68% in those with symptoms longer than 2 years (p < 0.05). Spontaneous or post-traumatic neurogenic symptoms responded to operation identically. The theoretical benefit of first rib resection to relieve mechanical compression of the brachial plexus is not evident from this review. Thorough removal of the scalene musculature and other myofascial anomalies, preferably through the supraclavicular approach, leads to less patient morbidity, shortens hospitalization, and is recommended for patients with neurogenic thoracic outlet syndrome requiring operative intervention.
对146例神经源性胸廓出口综合征患者共进行了168次原发性锁骨上减压手术。本报告比较了肋骨切除手术（锁骨上前中斜角肌切除术及第一肋骨切除术）与保留肋骨手术（仅锁骨上前中斜角肌切除术）的结果。所有有颈肋的患者均被排除。1983年至1992年间，由一名外科医生共进行了125例肋骨切除手术和43例保留肋骨手术。患者在症状和体征方面具有可比性。手术过程中，肋骨切除手术相关的胸膜损伤比例（59%）显著高于保留肋骨手术（40%）。接受肋骨切除手术的患者平均住院时间也延长了1天（p = 0.005）。两组的早期成功率无显著差异（肋骨切除组为83%，保留肋骨组为91%），恢复工作的情况也无差异（分别为52%和63%）。生存分析表明，两组的长期结果相似（2年时分别为69%和76%）。在原发性锁骨上胸廓出口综合征减压手术中，决定临床结果的唯一重要因素是术前症状持续时间。症状持续时间少于2年的患者中约83%手术成功，而症状持续时间超过2年的患者中这一比例仅为68%（p < 0.05）。自发性或创伤后神经源性症状对手术的反应相同。从本综述中未发现第一肋骨切除以缓解臂丛神经机械性压迫的理论益处。彻底切除斜角肌组织及其他肌筋膜异常，最好通过锁骨上入路，可降低患者发病率，缩短住院时间，推荐用于需要手术干预的神经源性胸廓出口综合征患者。
