Torasik outlet sendromu’nun cerrahi tedavisinde transaksiller yaklaşım sonuçları
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Dosyalar
Tarih
2006
Yazarlar
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Torasik Outlet Sendromu, toraks cerrahisinde tanı veya tedavi açısından en karmaşık klinik durumlardan biridir. Fizik tedaviden fayda görmeyen hastalarda tercih edilen en etkili tedavi birinci kosta ve varsa servikal kostanın cerrahi olarak çıkarılmasıdır. Bu retrospektif çalışmamızda, torasik outlet sendromu cerrahi deneyimlerimiz sunuldu. Ocak 1995 ile Aralık 2005 yılları arasında torasik outlet sendromu tanısı ile toplam 77 olgu opere edildi. Yaş ortalaması 35 (16-62) olan olguların 64’ü (%83,1) kadın ve 13’ü (%16,9) erkekdi. Yapılan toplam 93 operasyonun 15’i bilateral ve 1’i de nüks operasyondu. Olguların 29’unda (%63,1) elektromiyografi testi torasik outlet sendromu ile uyumluydu. Olguların 75’i (%97,4) nörojenik, 2’si (%2,6) vasküler torasik outlet sendromu olarak tesbit edildi. Tüm nörojenik torasik outlet sendromu operasyonlarında transaksiller yol tercih edildi. Rekürrent torasik outlet sendromu olan bir vakada posterior torakoplasti yaklaşımı uygulandı. Olguların 17’sinde (%22,1) servikal kosta mevcuttu. Olguların 36’sında (%47) fibromüsküler banda rastlandı. Cerrahi sonrası başarı ve başarısızlık oranları sırasıyla 72 (%93,5) ve 5 (%6,5). En sık rastlanan komplikasyonlar 21 olguda (%22,8) apikal pnömotoraks, 4 olguda (%4,3) ise yara enfeksiyonuydu. Mortalite gözlenmedi. Transaksiller yol torasik outlet sendromlu hastalarda en iyi yaklaşımdır, iyi kozmetik sonuçları ve az morbiditesiyle, birinci kosta ve bir arada bulunan patolojilerin birlikte çıkarılmasına olanak sağlar. Anahtar kelimeler: torasik outlet sendromu, transaksiller yaklaşım, supraklaviküler insizyon, cerrahi
Abstract
Thoracic outlet syndrome is one of the most complicated entities with respect to either diagnosis or treatment in thoracic surgery. Surgical removal of the first rib and cervical rib if present has been suggested as the optimal treatment of choice in patients who do not benefit from physiotherapy. In this retrospective study, our surgical experience with TOS were presented. A total of 77 cases operated with the diagnosis of thoracic outlet syndrome between January 1995 and December 2005. Sixty-four of the cases were females (83,1%) and 13 (16,9%) were males with a mean age of 35 (16-62). A total of 93 operations were performed with 15 bilateral and 1 recurrent operations. The electromyography test were consistent with thoracic outlet syndrome in 29 patients (63,1%). Diagnosis was neurogenic thoracic outlet syndrome in 75 (97,4%) and vascular in 2 (2,6%) patients. All neurogenic thoracic outlet syndrome operations were performed via transaxillary route. Posterior thoracoplasty approach was done for recurrent thoracic outlet syndrome in one case. A total of 17 (22,1%) case had cervical rib. Fibromuscular bands were observed in 36 (47%) case. The rates of favorable and poor surgical outcome were 72 (93,5%) and 5 (6,5%) respectively. The most common complication was an apical pneumothorax in 21 (22,8%) patients, followed by wound infection in 4 (4,3%) patients. Mortality was not observed.
Abstract
Thoracic outlet syndrome is one of the most complicated entities with respect to either diagnosis or treatment in thoracic surgery. Surgical removal of the first rib and cervical rib if present has been suggested as the optimal treatment of choice in patients who do not benefit from physiotherapy. In this retrospective study, our surgical experience with TOS were presented. A total of 77 cases operated with the diagnosis of thoracic outlet syndrome between January 1995 and December 2005. Sixty-four of the cases were females (83,1%) and 13 (16,9%) were males with a mean age of 35 (16-62). A total of 93 operations were performed with 15 bilateral and 1 recurrent operations. The electromyography test were consistent with thoracic outlet syndrome in 29 patients (63,1%). Diagnosis was neurogenic thoracic outlet syndrome in 75 (97,4%) and vascular in 2 (2,6%) patients. All neurogenic thoracic outlet syndrome operations were performed via transaxillary route. Posterior thoracoplasty approach was done for recurrent thoracic outlet syndrome in one case. A total of 17 (22,1%) case had cervical rib. Fibromuscular bands were observed in 36 (47%) case. The rates of favorable and poor surgical outcome were 72 (93,5%) and 5 (6,5%) respectively. The most common complication was an apical pneumothorax in 21 (22,8%) patients, followed by wound infection in 4 (4,3%) patients. Mortality was not observed.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Torasik Outlet Sendromu, Transaksiller Yaklaşım, Supraklaviküler İnsizyon, Cerrahi, Thoracic Outlet Sendrome, Transaxillary Approach, Supraclavicular İncision, Surgery
