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胸廓出口综合征的外科治疗 总被引:3,自引:0,他引:3
1980年至1993年间共收治胸廓出口综合征病人55例,行经腋路切口胸出口松解术62次,手术完全切断前,中斜角肌,切除带有骨膜的第一肋,松解锁骨下动脉和臂丛神经周围的纤维带,同时切除颈肋或过长的横突及其附着韧带,术后随访率为96.4%,平均随访7.7年,结果良好81.1%,改善13.2%,无变化5.7%,无复发病例,作者认为经腋路切口胸出口松解术是治疗胸廓出口综合征较理想的术式。 相似文献
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Hydatid cysts are usually located in the liver and lungs. Skeletal echinococcosis is relatively rare and that of the rib is
exceptional. Less than 50 cases of costal echinococcosis have been reported in the literature so far. To our knowledge, only
one case report of thoracic outlet syndrome due to echinococcal cyst in the first rib was described in 1995. Accurate pre-operative
diagnosis is important but may be challenging in some cases. Reported here is a case of echinococcosis of the first rib in
a young adult who was presented with thoracic outlet syndrome. Plain chest radiograph, CT scan and MRI were performed. The
imaging features were suggestive of a solitary aneurysmal bone cyst and the differential diagnosis included echinococcosis
of the first rib. The lesion was completely resected and the histopathological examination confirmed the diagnosis of echinococcosis. 相似文献
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《Surgery (Oxford)》2016,34(4):198-202
Thoracic outlet syndrome (TOS) is no longer considered to be a single entity. The syndromes are venous (V-TOS), arterial (A-TOS) and neurological (N-TOS), but may co-exist. The end stage of VTOS (Paget Schroetter syndrome or effort thrombosis of the subclavian vein) should be recognized early so that younger sportsmen and musicians in particular can be offered the opportunity of thrombolysis, decompression surgery and balloon venoplasty. Most uncomplicated cases of A-TOS and N-TOS can be treated conservatively with posture, diet, physiotherapy advice and reassurance. Complicated arterial TOS, with aneurysm or embolization, should be treated expeditiously by cervical rib excision and arterial reconstruction. Double crush syndromes are relatively common in patients with TOS. It is easier to treat carpal tunnel syndrome than N-TOS. Muscle wasting and pain are an indication for surgery in N-TOS. 相似文献
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目的:总结经腋路第一肋切除治疗胸廓出口综合征的经验,方法:采用经腋路第一肋切除术治疗下臂丛型胸廓出口综合征16例,结果:3例术中胸膜破裂,术后有胸闷和胸前区压迫感,其中1例前胸部可摸到少量的皮下捻发音;X线片示均有轻度气胸,除吸氧外,未做其它处理,术后3d基本恢复。16例中1例在术后3个月复发,再次行前中斜角肌切除术,术后症状缓解,2例在术后8个月复发,4例在术后12个月出现前臂内侧和手尺侧轻度麻木及肩颈部不适,但比术前要轻得多;该6例经用药后症状基本消失,其余患者症状完全解除,未复发,总治愈率为81.25%,8例第一肌间背仙肌萎缩者,3例患者完全恢复(术后25-28个月),2例部分恢复(术后18-23个月),该5例的爪形手畸形均已消失,结论:经腋路切除第一肋治疗下臂丛型胸廓出口综合征,伤口隐蔽,损伤小,手术后复发率较低。 相似文献
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Henrik Nuutinen Jussi M Krkkinen Kimmo Mkinen Voitto Aittola Petri Saari Janne Pesonen 《Interactive Cardiovascular and Thoracic Surgery》2021,33(5):734
Open in a separate windowOBJECTIVESThe aim was to determine long-term outcomes over a decade after first rib resection (FRR) in patients with neurogenic thoracic outlet syndrome (NTOS). A secondary aim was to investigate correlation of residual rib stump with long-term symptoms.METHODSThis ambispective cohort included patients who underwent transaxillary FRRs for NTOS between 1998 and 2007. Short-term outcomes at 3-month clinical follow-up were retrospectively collected from medical records. Patients who agreed to participate in the study were invited to a long-term clinical follow-up in 2019. Disabilities of Arm, Shoulder, and Hand Score and Cervical Brachial Symptom Questionnaire were used. A chest X-ray limited to a clavicular projection was taken, and the length of the residual first rib was measured.RESULTSTwenty patients {mean age 41.8 [standard deviation (SD): 10.3 years]} who underwent 27 FRRs participated in the study. The mean follow-up time was 14.9 (SD: 3.6) years. Excellent or good recovery was noted after 16 (59.3% of operated arms) operations in the short-term follow-up and 22 (81.5%) operations in the long-term follow-up. No reoperations were necessary for residual symptoms. The mean Cervical Brachial Symptom Questionnaire score was 26.7 (SD: 28.2) (maximum 120), and the Disabilities of Arm, Shoulder, and Hand Score was 21.1 (SD: 18.4) (maximum 100) points. Twenty-six patients (96.3%) had a noticeable residual first rib stump. The mean length of the residual first rib was 28.9 (SD: 9.5) mm. More than 30-mm rib stump did not indicate a worse long-term outcome.CONCLUSIONSThis study showed good long-term outcome without symptom recurrence after FRR for NTOS. In most patients, after surgery, quality of life and ability to work improved. Residual rib stump length was not associated with the treatment outcome. 相似文献
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A.D. Lee N.K. Shyamkumar S. Nayak S. Agarwal B. Perakath 《European journal of vascular and endovascular surgery》2005,29(6):611-612
Aneurysms of collateral arteries are unusual. A case of transverse cervical artery aneurysm as the sole presentation of vascular thoracic outlet syndrome is presented and the relevant literature reviewed. 相似文献
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Thoracic outlet syndrome (TOS) consists of a group of distinct pathologies arising as a result of compression of structures at the thoracic outlet. The structures at risk are, from anterior to posterior, the subclavian vein, subclavian artery and brachial plexus. Compression or impingement causes venous (VTOS), arterial (ATOS) or neurogenic (NTOS) TOS. NTOS is the most common presentation, caused by compression of the brachial plexus at the scalene triangle or pectoralis minor space. Other compression syndromes at the carpal and cubital tunnels should be excluded. Management is usually conservative, employing physiotherapy and postural exercises, but pain or muscle wasting may be indications for surgery. VTOS is caused by compression of the subclavian vein at the costoclavicular junction, resulting in venous thrombosis, the Paget-Schroetter syndrome, often as a result of exercise in fit young muscular people or musicians. Positional swelling of the upper limb without thrombosis is termed McCleery's syndrome. In the presence of thrombosis, clot lysis, first rib excision and venoplasty may be indicated. ATOS occurs due to compression of the subclavian artery at the scalene triangle, often in association with an anomalous bony structure, such as cervical rib, causing post-stenotic aneurysmal dilation of the artery, thrombosis and embolization. Acute upper limb ischaemia necessitates urgent cervical rib excision and arterial reconstruction. 相似文献
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According to the literature, thoracic outlet syndrome (TOS) secondary to the malunion of displaced fractures of the clavicle is rare. Various surgical methods, including simple neurolysis, resection of the first rib or clavicle and corrective osteotomy, have been reported. We report a case of TOS secondary to malunion of the clavicle that was treated by an anterior and middle scalenectomy without a rib resection. 相似文献