Fantini G A
Department of Surgery, New York Hospital, New York 10021, USA.
Am J Surg. 1996 Aug;172(2):200-4. doi: 10.1016/S0002-9610(96)00153-5.
The traditional approach to decompression of the thoracic outlet has been by transaxillary resection of the first rib. Recently, the trend has been toward a more selective and tailored surgical approach via the supraclavicular route.
During a 51-month period, 14 consecutive patients underwent decompressive surgery of the thoracic outlet via the supraclavicular approach. There were ten women and four men; mean age was 44 years. Indications for operation were arterial (n = 3), venous (n = 2) and neurogenic (n = 9). Mean follow-up was 31 months. Operation consisted of resection of the anterior scalene and medial aspect of the middle scalene muscles and brachial plexus neurolysis for neurogenic indication, with first rib resection reserved for vascular complications.
Operations performed for vascular complication were successful and uncomplicated, with good clinical outcome. Seven of nine operations (78%) performed for neurogenic indication produced marked relief of symptoms, while two (22%) resulted in no clinical change. Complications consisted of transient scapular winging (n = 1) and transient diaphragmatic paralysis (n = 2).
A selective approach to thoracic outlet decompression, consisting of anterior scalenectomy and brachial plexus neurolysis for neurogenic symptoms, and reserving first rib resection for arterial and venous indications, is a safe procedure and yields satisfactory results in appropriately selected patients.
传统的胸廓出口减压方法是经腋路切除第一肋。近来，趋势是通过锁骨上途径采用更具选择性和针对性的手术方法。
在51个月期间，14例连续患者经锁骨上途径接受了胸廓出口减压手术。其中女性10例，男性4例；平均年龄44岁。手术指征为动脉型（n = 3）、静脉型（n = 2）和神经型（n = 9）。平均随访31个月。手术包括切除前斜角肌和中斜角肌内侧部分，并对神经型指征进行臂丛神经松解术，仅在出现血管并发症时才切除第一肋。
针对血管并发症进行的手术成功且未出现并发症，临床效果良好。针对神经型指征进行的9例手术中，7例（78%）症状明显缓解，2例（22%）临床症状无变化。并发症包括短暂性肩胛翼状畸形（n = 1）和短暂性膈神经麻痹（n = 2）。
胸廓出口减压的选择性方法，包括针对神经型症状进行前斜角肌切除术和臂丛神经松解术，并将第一肋切除术保留用于动脉型和静脉型指征，是一种安全的手术方法，在适当选择的患者中可取得满意的结果。
