胸廓出口徵候群之外科治療

Surgical Treatment of Thoracic Outlet Syndrome

黃克明(Ker-Ming Huang) ； 李世俊(Shih-Chun Lee)

《Journal of Medical Sciences》 6卷4期 (1986/06) Pp. 333-339

摘要

胸廓出口徵候群，為一較不常見的疾病，表現的症狀與胸廓出口處神經、血管受壓迫的程度有關。其原因多半是此處解剖結構異常或因外傷而改變所造成的。外科治療之目的，在改變矯正消除這些異常結構對神經血管所產生之壓迫。胸廓出口徵候群，在臨床上常與頸椎（Cervical spine）、頸部脊髓（Cervical cord）、腋下臂神經叢（axillary plexus）、上肢之週邊神經血管（peripheral neurovascular diseases of upper limbs）、冠狀動脈（coronary arterial disease）等之病變症狀相仿，因此需要藉著各種檢查來排除這些可能性。目前胸廓出口徵候群之外科治療方針為，切除頸肋（resection of cervical rib），切除第一根肋骨（resection of 1st rib），切斷前斜角肌（Scalenectomy anticus），切斷壓迫之頸韌帶（division of cervical ligment），以及切除鎖骨（claviculectomy）等。來解除它們對臂神經叢，鎖骨下動脈，鎖骨下靜脈等之壓迫。如因長期受壓迫而形成動脈瘤，動靜脈栓塞血栓時尚需要施行血管重建手術。手術之技巧有經由腋下切口（transaxillary incision），鎖骨上切口（Supraclavicular incision)，鎖骨下切口（Infraclavicular incision），以及肩胛骨旁切口（posterior parascapularincision）等方法來施行。三軍總醫院胸腔外科有三例接受外科治療之胸廓出口徵候群，其中一例是兩側性的，其餘兩例為單側性。有一例手術時發現有頸肋。三例患者進行四次手術，其中三次為經由腋下切除第一根肋骨，切斷前斜角肌，一次為配合腋下與鎖骨上之切口切除頸肋，切除第一根肋骨，及切斷前斜角肌。

關鍵字

胸廓出口徵候群

並列摘要

Thoracic outlet syndrome is a less common disease. Its symptoms and signs are related to the compression of neurovascular bundles at the superior thoracic outlet. The etiology is abnormal outlet components, or anatomical structure changes caused by trauma or not. The surgical treatment of thoracic outlet syndrome is to relieve the neurovascular structures that compressed by those abnormal outlet components or changed structures.From Dec. 1983 to July 1985, the Division of Thoracic Surgery of Tri-Service General Hospital had three cases of surgically treated thoracic outlet syndrome. One of them is a 31-year-old female who associates with cervical rib, and the other two 21 & 22-year-old males are not.Before operation all of them received precise examinations enclude E.K.G., somato-sensory motor dermatome, U.N.C.V. study, E.M.G. study, somatosensory evoked electrical potential study, radial arterial P.V.R. study, cervical roentgenography, two position aortography, and surbclavian venography. These three cases failed to physical therapy. Each of them received four operations. Three occasions of transaxillary resection of the first rib & anterior scalenectomy are performed on the two males. The only female received transaxillar & supraclavicular approaches to resect the cervical and first rib, and performed the anterior scalenectomy. After the surgical intervention they have gotten improvement.

並列關鍵字

Thoracic outlet syndrome