锁骨上入路内窥镜手术治疗胸廓出口综合征的应用解剖及临床应用

Anatomical study and clinical application of supraclavicular endoscopic surgery for thoracic outlet syndrome

目的报道锁骨上入路内窥镜手术治疗胸廓出口综合征的解剖学研究与临床疗效。方法选取成人标本,对颈外侧区及颈前区结构进行解剖学研究并经锁骨上入路模拟内窥镜手术,确定该术式的最佳路径。根据解剖研究结果,锁骨上入路内窥镜手术应用于临床治疗胸廓出口综合征。结果解剖研究表明锁骨上入路内窥镜手术治疗胸廓出口综合征的最佳手术入路点为头偏向健侧60°轻微后仰时,胸骨头至乳突全长60%处与胸锁乳突肌后缘的交点;颈横动脉为镜下操作的解剖特异标志。临床完成锁骨上入路内窥镜手术5例,术后平均随访25个月(12~36个月),按照Roos评定标准,优4例,良1例。结论锁骨上入路内窥镜手术治疗胸廓出口综合征有其解剖学基础,临床应用安全可行,能有效解除臂丛神经血管受压征。

Objective To report the anatomical study and clinical effect of supraclavicular endoscopic surgery for thoracic outlet syndrome.Methods Adult specimens were selected to study anatomically the structures of the lateral cervical region and the anterior cervical region,and the supraclavicular approach was selected for endoscopic simulation operation to determine the optimal approach point.According to the results of anatomical study,endoscopic supraclavicular approach was applied in the treatment of thoracic outlet syndrome.Results Anatomic study showed that the best approach of endoscopic surgery was the intersection point between the sternocleidomastoid muscle and 60%of the total length of the sternocleidomastoid muscle and the posterior margin of the sternocleidomastoid muscle when the head was slightly inclined to the opposite side at 60°.The transverse cervical artery was the anatomic specific marker of endoscopic operation.Five patients underwent endoscopic supraclavicular approach surgery clinically.The mean follow-up time was 25 months(12~36 months).According to Roos criteria,4 cases were excellent and 1 case was good.Conclusions Endoscopic surgery via supraclavicular approach for thoracic outlet syndrome has its anatomical basis,and its clinical application is safe and feasible.It can effectively relieve the compression of brachial plexus in thoracic outlet syndrome with satisfactory effect.