Jiang H. Surgical Treatment of Patients with Thoracic Outlet Syndrome

The dissertation is devoted to the issues of surgical treatment of patients with thoracic outlet syndrome. Impaired function of the brachial plexus due to the affected ratio between nerve, vascular and adjacent musculoskeletal structures results in pain of varying degrees, decreased muscle strength, impaired sensitivity and trophic disorders in the upper limb. The dissertation research is based on the results of a comprehensive examination and outcomes of surgical treatment of 82 patients with thoracic outlet syndrome (TOS) who were treated in the Department of Reconstructive Neurosurgery with X-ray Operating Room State Institution “Institute of Neurosurgery named after acad. A.P. Romodanov, National Academy of Medical Sciences of Ukraine” from 1997 to 2015. Patients with scalenus anterior syndrome (n=65) underwent brachial plexus neurolysis, angiolysis of the subclavian artery and the subclavian vein with myotomy of scalene muscles (group 1); brachial plexus neurolysis, angiolysis of the subclavian artery and the subclavian vein, scalenotomy and first rib resection (group 2); brachial plexus neurolysis, angiolysis of the subclavian artery and the subclavian vein, scalenotomy and implantation of electrostimulation system (group 3). Patients with cervical rib syndrome (n=17) had surgical treatment, including brachial plexus neurolysis, angiolysis of the subclavian artery and the subclavian vein, scalingotomy and resection of the cervical rib (group 4); brachial plexus neurolysis, angiolysis of the subclavian artery and the subclavian vein, scalenotomy, cervical rib resection combined with the implantation of a system for long-term electrical stimulation (group 5). The early and long-term efficacy of surgical intervention was studied depending on the age of patients, the duration of the disease and the volume of surgical intervention. It has been established that surgical treatment of patients with thoracic outlet syndrome allows the statistically significant reduction in pain in the early and long-term periods in all groups of patients. The dynamics of pain changes in different age groups in the early postoperative period differs statistically insignificantly (p = 0.59); in the long-term period, the dynamics of pain changes is statistically significant (p1-2 = 0.01; p1-3 = 0.036). Early electrical stimulation in the postoperative period contributes to the achievement of a stable and safe analgesic effect. Prolonged electrical stimulation also ensures the maximum reduction in the period of recovery and a greater volume of restoration of the sensitive and motor functions of the upper limb. The scheme of curative and diagnostic measures related to the management of patients with thoracic outlet syndrome has been developed and put into practice. It is a clear sequence of examination and treatment measures aimed at the timely determination of indications for surgical treatment and rapid pain regression.