胸廓出口症候群之航醫鑑定與缺點免計考量

Aeromedical consideration of thoracic outlet syndrome

許廷輔(Ting-Fu Hsu) ； 林岡樺(Gang-Hua Lin) ； 張庭嘉(Ting-Chia Chang) ； 袁名璟(Ming-Ching Yuan) ； 張嘉緯(Chia-Wei Chang)

《中華民國航空醫學暨科學期刊》 30卷2期 (2016/12) Pp. 101-108

https://doi.org/10.7011/JAMSROC.201612_30(2).0003

摘要

胸廓出口症候群係指神經、靜脈與動脈通過胸廓出口途中受壓迫而引發神經血管症狀。我國航空醫務教範將罹患胸廓出口症候群之空勤人員判定為體位不及格，然而該疾病在經適當治療後，仍有機會勝任飛行任務。神經型胸廓出口症候群症狀以上肢麻痛、感覺異常為主，治療第一線為保守治療，症狀持續者需進行手術減壓。根據美國缺點免計規範，患者應接受電生理檢查及評估功能之恢復狀況而考量是否給予缺點免計。靜脈型胸廓出口症候群症狀以靜脈回流受阻造成上肢腫脹、疼痛為主。檢查須注意肺栓塞等血栓相關併發症。治療建議行血栓溶解術合併減壓手術，以降低血栓復發率。參據美國空軍缺點免計規範及國際航空醫學專業期刊案例探討，個案功能恢復至不影響飛行安全疑慮下，可予以復飛。如需長期服用抗凝血藥物，需定期追蹤凝血功能。動脈型胸廓出口症候群以手部缺血導致之症狀為主。手術減壓為主要治療方式，若合併嚴重堵塞，因有較高血管壞死機率，可考慮合併血管繞道手術。依據美國空軍缺點免計手冊建議，動脈型需依個案別狀況作缺點免計考量。

關鍵字

胸廓出口症候群 ； 航空醫務教範 ； 航空醫學考量 ； 缺點免計

並列摘要

According to the current ROC Aeromedical Practice Manual, airmen who are diagnosed with thoracic outlet syndrome (TOS) are disqualified. However, after adequate treatment, they still have the chance to return to flying status. Neurogenic TOS could cause pain, numbness, dysesthesia and weakness and should initially be managed conservatively. Patients with persistent neurogenic symptoms should receive decompression operations. Waiver requests should include results of electrophysiological studies and functional demonstration of satisfactory recovery. Symptoms of venous TOS include swelling, pain, and cyanosis. Examinations should be done to exclude the thromboembolic complications, such as pulmonary embolism. Catheter-directed thrombolysis with surgical decompression is preferred to reduce the risk of reocclusion of the subclavian vein. A pilot could be granted waiver after functional evaluation proven no compromise of aviation safety. The airman should be restricted from flying high-performance or single- pilot aircraft if continued, prolonged anticoagulation is required. Also, regular thrombophilia evaluation is required. Arterial TOS mostly presents with ischemic symptoms localized in upper extremities; surgical decompression is usually performed. By-pass surgery should be considered for severe arterial occlusion in view of possible vascular necrosis. Waiver potential should be handled on a case by case basis.

並列關鍵字

thoracic outlet syndrome ； waiver guide ； waiver ； aeromedical consideration