动脉型胸廓出口综合征误漏诊分析  

Analysis of Misdiagnosis and Missed Diagnosis of Arterial Thoracic Outlet Syndrome

作　　者：杨根欢 廖鹏志 刘新农 汪岩[1] 贾玉龙[1] 沈晨阳 YANG Genhuan;LIAO Pengzhi;LIU Xinnong;WANG Yan;JIA Yulong;SHEN Chenyang(Department of Vascular Surgery,Beijing Tiantan Hospital Affiliated to Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院血管外科,北京100070

出　　处：《临床误诊误治》2024年第6期19-23,共5页Clinical Misdiagnosis & Mistherapy

基　　金：首都医科大学教育教学改革研究课题(2023JYY230)。

摘　　要：目的探讨动脉型胸廓出口综合征(aTOS)的临床特点、影像学表现及误漏诊原因、防范措施。方法回顾性分析2017年9月—2023年9月收治的曾误漏诊的aTOS 4例的临床资料。结果本组3例表现为椎动脉起始以远的锁骨下动脉重度狭窄,1例表现为锁骨下动脉中段闭塞,其中2例合并同侧腋动脉重度狭窄。本组3例误诊为动脉粥样硬化性病变,行介入治疗;1例右颈动脉闭塞漏诊aTOS,因临床症状不明显,行保守治疗。1例2次支架植入术后均发生再次闭塞,最终行左颈总动脉-左腋动脉人工血管搭桥术。1例发生支架植入术后再闭塞,再次球囊扩张后维持通畅。1例行支架植入术后,维持通畅。结论aTOS临床上易误诊为动脉粥样硬化性病变。临床上对椎动脉起始以远的锁骨下动脉狭窄或腋动脉狭窄患者需考虑为aTOS,aTOS的治疗建议行开放手术。Objective To explore the clinical characteristics and imaging manifestations,cause of misdiagnosis and missed diagnosis,and preventive measures of arterial thoracic outlet syndrome(aTOS).Methods The clinical data of 4 patients with aTOS who experienced misdiagnosis and missed diagnosis and were admitted between September 2017 to September 2023 were retrospectively analyzed.Results Three patients presented with severe stenosis of the subclavian artery far from the origin of the vertebral artery,one patient presented with occlusion of the middle segment of the subclavian artery,including 2 patients who had severe stenosis of the ipsilateral axillary artery.Three patients were misdiagnosed as atherosclerotic lesions and underwent interventional treatment,and one patient was considered as having aTOS misdiagnosed due to right carotid artery occlusion and received conservative treatment due to unclear clinical symptoms.One patient experienced secondary occlusion after two stent implantation surgeries,and ultimately underwent carotid-subclavian bypass.One patient experienced secondary occlusion after stent implantation and maintained patency after balloon dilation,and one patient maintained patency after undergoing stent implantation surgery.Conclusion aTOS is more likely to be misdiagnosed as atherosclerotic lesions in clinical practice.For patients with subclavian artery stenosis far from the origin of the vertebral artery or axillary artery stenosis,aTOS should be considered.Open surgery is recommended for the treatment of aTOS.

关 键 词：胸廓出口综合征 锁骨下动脉 腋动脉 血管狭窄 血管闭塞 误诊 动脉粥样硬化 漏诊 

分 类 号：R654.3[医药卫生—外科学]