Aim

Thoracic outlet syndrome (TOS) is a condition that occurs when the cervical neuro-vascular bundle becomes compressed at one of the three narrow areas of the thoraco-cervico-axillary region. Conservative management is the first line of treatment. Patients who do not respond to conservative management should be treated surgically. The aim of this review is to present our experience with the surgical management of TOS in pediatric patients.

Methods

We retrospectively reviewed the outcomes of all patients with TOS operated at our Hospital between 2001 and 2020. We collected all demographic data, clinical features, imaging data, type of operation performed, intraoperative findings, complications and recurrence.

Results

We operated 9 patients within the study period. The median age at surgery was 14 (7 to 17) years. A transaxillary approach was used in 7 patients and a supraclavicular approach in 2. There was only one minor intraoperative complication (violation of the pleural space). There were no postoperative complications. The median length of stay was 3 (2 to 4) days. All patients were extubated in the operating room. Two patients developed symptoms on the contralateral side. One of these underwent a successful contralateral transaxillary Roos operation. The follow-up was 4 months to 20 years. All patients are asymptomatic.

Conclusion

We believe that the Roos operation is a safe and effective treatment with excellent long-term outcomes for children with TOS that fail conservative management.

中文翻译：

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小儿胸廓出口综合征的外科治疗

目标

胸廓出口综合征 (TOS) 是颈椎神经血管束在胸-颈-腋窝区域的三个狭窄区域之一受压时发生的病症。保守治疗是第一线治疗。对保守治疗无效的患者应接受手术治疗。本综述的目的是介绍我们在儿科患者 TOS 手术治疗方面的经验。

方法

我们回顾了 2001 年至 2020 年间在我院接受手术的所有 TOS 患者的结果。我们收集了所有人口统计学数据、临床特征、影像学数据、手术类型、术中发现、并发症和复发。

结果

我们在研究期间对 9 名患者进行了手术。手术的中位年龄为 14（7 至 17）岁。7 名患者使用了经腋下入路，2 名患者使用了锁骨上入路。只有一个轻微的术中并发症（侵犯胸膜腔）。没有术后并发症。中位住院时间为 3（2 至 4）天。所有患者均在手术室拔管。两名患者在对侧出现症状。其中一个成功地进行了对侧经腋窝 Roos 手术。随访4个月至20年。所有患者均无症状。

结论

我们认为，对于保守治疗失败的 TOS 儿童，Roos 手术是一种安全有效的治疗方法，具有良好的长期疗效。