Surgical Treatment for Bilateral Thoracic Outlet Syndrome (TOS)

兩側性胸廓出口症候群（或土司TOS症候群）之處理策略

莊垂慶(David Chwei-Chin Chuang) ； 呂榮國(Rong-Kuo Lyu)

《中華民國整形外科醫學會雜誌》 14卷4期 (2005/12) Pp. 288-302

https://doi.org/10.7096/JPSA.200512.0288

摘要

土司(TOS)症候群乃是胸廓出口神經血管壓迫症候群。主要是發生在斜角(scalene)三角地帶。雖然其名稱、症狀、診斷及治療仍有爭論，但 TOS確實存在。作者由1993年至2004年（11年期間），共手術治療四十二位有TOS嚴格挑選的病患。其中，有五位是兩側性TOS，在不同之時間接受手術治療。手術的方法是由鎖骨上窩切傷口，取得幾乎所有之前斜角肌(scalene anterior)及第一胸椎肋骨及頸椎肋骨（如有存在）。所有五位均得症狀之改善及力學之加強。後遺症少。沒有人再發。結論，由於對解剖學之更認識、病理原因之更加了解、診斷性之更正確、以及手術技術之改良，即使是兩側性難纏的TOS，仍可用外科之方法來治療。

並列摘要

Thoracic outlet syndrome (TOS) is a complex entrapment syndrome of the brachial plexus in the thoracic outlet, specifically at the scalene triangle. Although it presents a controversial topic with regards to nomenclature, symptoms, signs, tests, diagnosis, and treatment, it nevertheless exists as a clinical entity. From 1993 to 2004, 42 highly selected patients were diagnosed with 47 TOS were operated on at Chang Gung Memorial Hospital by the senior author (DCC Chuang). Among them five patients with bilateral TOS underwent surgical intervention on both sides. Routine surgical decompression for TOS, including near total resection of the scalene anterior muscle, first rib and cervical rib if present was performed. All patients achieved a good result with release in symptoms and signs, and an increase in limb or hand muscle strength. Complications due to the operation were minimal. There were no cases of symptoms recurrence during one to ten years of post-operative follow-up. The scalene anterior muscle and dynamic first rib anomalies play an important role in the pathophysiology of TOS. Advances in our understanding, evaluation and diagnosis, and improved surgical technique have lead to more predictable outcome. In conclusion, surgical intervention, even for bilateral TOS, is warranted.

並列關鍵字

thoracic outlet syndrome