JoVE Journal > Medicine
Summary
Abstract
Introduction
Protocol
Results
Discussion
Disclosures
Acknowledgements
Materials
References
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의학

经腋窝第一肋骨切除术治疗胸廓出口综合征

Published: September 13, 2020
doi:
10.3791/59659
, ,
1Department of Thoracic Surgery,Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, 2Department of Thoracic Surgery,Bakırköy Dr. Sadi Konuk Training and Research Hospital, 3Department of Thoracic Surgery,Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital

Summary

在这里，我们提出了第一肋骨经腋窝切除术的方案，用于治疗由臂丛神经、锁骨下静脉和动脉受压引起的胸廓出口综合征。

Abstract

胸廓出口综合征 （TOS） 是一种常见的疾病，会导致生产力显着下降。经腋窝第一肋骨切除术 （TFRR） 方案已用于 TOS 中受困神经血管结构的减压。在其他外科手术中，TFRR 的优点是复发率最低，美容效果更好。TFRR 的缺点是它提供了一个狭窄而深的工作走廊，这使得获得血管控制具有挑战性。

Introduction

斜角三角臂丛神经、锁骨下动脉或静脉的压迫在临床上称为胸廓出口综合征 （TOS），最初由 Peet 等人描述1。胸廓出口综合征根据潜在病因细分为神经源性 （NTOS）、动脉 TOS 和静脉 TOS1。NTOS患者（93-95%的TOS病例）表现为疼痛、麻木和同侧无力。静脉 TOS 患者 （3-5%） 表现为静脉血栓形成，动脉 TOS 患者 （1-2%） 表现为动脉血栓栓塞事件和缺血。TOS的保守治疗包括药物治疗和物理治疗，是TOS病例的首选。手术治疗方式包括减压手术，并在保守治疗失败后进行2.减压技术包括经腋窝第一肋骨切除术 （TFRR）、锁骨上第一肋骨切除术 （SFRRS）、扁平体切除术（无需通过锁骨上或经腋窝切除第一肋骨）和后入路第一肋骨切除术 （PA-FRR）3。经腋窝第一肋骨切除术是 Roos 等人于 1966 年描述的一种技术，是治疗 TOS 4,5 的有效方法。TFRR 的主要目标是完全切除最后一根颈肋和第一根胸肋骨，并减压下面的神经血管束。

血管 TOS （VTOS） 通过 CT 血管造影、彩色双功 USG 和动脉造影或静脉造影进行诊断，而 NTOS 通过 X 射线、电诊断检查（针脊髓电图）、彩色双功多普勒 USG 和颈部 MRI 进行诊断。术前应咨询物理治疗师和精神科医生，以排除其他疾病。在前斜角肌注射利多卡因缓解症状也是诊断和预测 NTOS 患者手术获益的良好指标6。

Protocol

本研究是根据赫尔辛基宣言和当地临床伦理委员会 （2018/09） 进行的。 1. 体格检查 注意：用于诊断 TOS 的激发试验如 图 1 所示。 对于Adson试验（斜角肌试验， 图1A），使患者的肩部向外旋，轻微外展和一点点伸展，并触诊桡动脉搏动。将患者的头部向后伸展并旋转到被测试的肩膀。让患者吸气并屏住?…

Representative Results

临床结果本研究共纳入15例患者。3例患者（20%）为男性，12例（80%）为女性。患者平均年龄分别为30.6岁±8.98岁。所有男性参与者和 5 名女性参与者都是体力劳动者。NTOS组最常见的主诉是手臂-前臂疼痛和麻木、握力无力和低水萎缩。在术后临床随访中，询问患者的感觉异常和疼痛严重程度、总体满意度、活动和工作状态。在术前和术后评估QuickDASH评分和EMG值。术前和术后肌电图测?…

Discussion

TFRR 是治疗 TOS9、10、11 最常用的手术技术。TFRR 的优点是它提供了更好的美容效果，在腋窝有一个隐藏的切口，而无需切割肌肉以到达手术区域。它的缺点是工作空间相对狭窄和深。锁骨上入路是动脉 TOS 治疗的首选方法，可降低锁骨下动脉损伤的风险12。锁骨下静脉在静脉 TOS 治疗中常采用锁骨下入路，后外?…

Disclosures

The authors have nothing to disclose.

Acknowledgements

没有

Materials

Ag Debakey vascular forceps 24 cm, 3.5 mm Lawton medizintechnik 30-0032 Check the hemorrhage
Bone chisels curved 13×9.1/2'' Aesculap Inc. MB-992R Dissect the periost of the first rib
Doyen-stille retractor 24 cm Lawton medizintechnik 20-0650 Skin- muscle retraction
Foerster sponge forceps straight Lawton medizintechnik 07-0156 For swabbing
Luer stille bone rongeur curved 27 cm Lawton medizintechnik 38-0703 Bone punches
Luer stille rongeur straight 22 cm Lawton medizintechnik 38-0400 Rib cutter
Mayo hegar needle holder 20.5 cm Lawton medizintechnik 08-0184 Suturing
Metzenbaum scissors curved delicate 23 cm Lawton medizintechnik 05-0665 Dissection
Overholt curved forceps delicate 30.5 cm Lawton medizintechnik 06-0807 Split the scalen muscles from the rib
Roberts art forceps straight 24 cm Lawton medizintechnik 06-0370 For sponge and remove remain bone
Roux retractor medium size 15.5 cm Lawton medizintechnik 20-0402 Wound retraction
Semb rasparotry 22,5 cm, 12mm Lawton medizintechnik 39-0252 Dissect the muscle of the first rib
Smith peterson model curved osteotome 13×205 mm Lawton medizintechnik 46-0783 Dissect the muscle of the first rib
Stille -giertz rib shears 27 cm Lawton medizintechnik 38-0200 First rib cutting
Stille osteotome 8×205 mm Lawton medizintechnik 46-0248 Dissect the periost of the first rib
Wagner rongeur 5.5×210 mm Lawton medizintechnik 53-0703 Punches
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References

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Tags

Keywords: Transaxillary First Rib ResectionThoracic Outlet SyndromeBrachial Plexus CompressionSubclavian Vein CompressionSubclavian Artery CompressionAdson TestCostoclavicular Brace TestHyperabduction TestRoos TestQuickDASH QuestionnaireElectromyographyCompound Motor Action PotentialSensory Nerve Action PotentialNerve Conduction VelocityF-wave Latency
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Akkuş, M., Kose, S., Sönmezoğlu, Y. Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome. J. Vis. Exp. (163), e59659, doi:10.3791/59659 (2020).
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