{"id":2798,"date":"2024-11-20T23:48:32","date_gmt":"2024-11-20T23:48:32","guid":{"rendered":"https:\/\/kamranaghayev.com\/tekrarlayan-torasik-outlet-sendromu\/"},"modified":"2026-11-03T16:32:34","modified_gmt":"2026-11-03T16:32:34","slug":"tekrarlayan-torasik-outlet-sendromu","status":"publish","type":"post","link":"https:\/\/kamranaghayev.com\/tr\/tekrarlayan-torasik-outlet-sendromu\/","title":{"rendered":"Kal\u0131c\u0131 (Persistan) ve Tekrarlayan (N\u00fcks) Torasik Outlet Sendromu"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\" id=\"h-what-is-persistent-and-recurrent-thoracic-outlet-syndrome\">Kal\u0131c\u0131 (persistan) ve tekrarlayan (n\u00fcks) torasik outlet sendromu nedir<\/h2>\n\n<p class=\"wp-block-paragraph\">Persistan <a href=\"https:\/\/kamranaghayev.com\/tr\/torasik-outlet-sendromu-nedir\/\">torasik outlet sendromu (TOS)<\/a>, ameliyattan sonra hastal\u0131\u011f\u0131n devam etti\u011fi veya daha da k\u00f6t\u00fcle\u015fti\u011fi bir durumdur. Tekrarlayan torasik \u00e7\u0131k\u0131\u015f sendromu persistansdan biraz farkl\u0131d\u0131r. N\u00fcks veya rek\u00fcrens, <a href=\"https:\/\/kamranaghayev.com\/tr\/torasik-outlet-sendromu-belirtiler-riskleri\/\">TOS semptomlar\u0131n\u0131n <\/a>k\u0131sa bir iyile\u015fme d\u00f6neminden sonra geri d\u00f6nmesi anlam\u0131na gelir. Bu k\u0131sa zaman dilimi genellikle &#8220;balay\u0131&#8221; olarak adland\u0131r\u0131l\u0131r. \u015eik\u00e2yetler \u00e7e\u015fitli nedenlerle s\u00fcrebilir ya da geri d\u00f6nebilir ve hangisinin ge\u00e7erli oldu\u011funu bulmak, adland\u0131rmaktan daha \u00f6nemlidir. \u0130yile\u015fmenin ilk haftalar\u0131nda ve aylar\u0131nda a\u011fr\u0131 beklenen bir durumdur ve tek ba\u015f\u0131na n\u00fcks belirtisi de\u011fildir.<\/p>\n\n<h2 class=\"wp-block-heading\" id=\"h-causes-of-recurrent-thoracic-outlet-syndrome\">Tekrarlayan Torasik Outlet Sendromunun Nedenleri<\/h2>\n\n<h3 class=\"wp-block-heading\" id=\"h-wrong-diagnosis\">Yanl\u0131\u015f te\u015fhis<\/h3>\n\n<p class=\"wp-block-paragraph\">Torasik outlet sendromunu taklit edebilecek bir\u00e7ok durum vard\u0131r. <a href=\"https:\/\/kamranaghayev.com\/tr\/servikal-disk-herniasyonu\/\">Servikal disk herniasyonu<\/a>, omuz eklemi sorunlar\u0131, fibromiyalji, Raynaud hastal\u0131\u011f\u0131 TOS olarak yanl\u0131\u015f te\u015fhis edilebilir. <\/p>\n\n<ol class=\"wp-block-list\">\n<li class=\"\"><a href=\"https:\/\/kamranaghayev.com\/tr\/servikal-disk-herniasyonu\/\">Servikal disk herniasyonu.<\/a> TOS ve disk herniasyonu aras\u0131nda bir\u00e7ok ortak \u00f6zellik vard\u0131r. Her iki hastal\u0131k sinir s\u0131k\u0131\u015fmas\u0131 ile ili\u015fkilidir. Dolay\u0131s\u0131yla a\u011fr\u0131, uyu\u015fma ve g\u00fc\u00e7s\u00fczl\u00fck gibi temel semptomlar her iki hastal\u0131kta mevcuttur. Bu nedenle <a href=\"https:\/\/en.wikipedia.org\/wiki\/Differential_diagnosis\" target=\"_blank\" rel=\"noopener\">ay\u0131r\u0131c\u0131 tan\u0131<\/a> zor olabilir. Durumu daha da zorla\u015ft\u0131rmak ad\u0131na, baz\u0131 hastalarda ayn\u0131 anda servikal disk herniasyonu ve TOS olabilir. <\/li>\n\n\n\n<li class=\"\"><a href=\"https:\/\/www.nhs.uk\/conditions\/fibromyalgia\/\" target=\"_blank\" rel=\"noopener\">Fibromiyalji<\/a> \u00e7ok kolay bir \u015fekilde TOS ile kar\u0131\u015fabilir. Fibromiyalji hastalar\u0131nda ana belirti a\u011fr\u0131d\u0131r. A\u011fr\u0131l\u0131 b\u00f6lge TOS&#8217;a \u00e7ok benzeyebilir, ancak fibromiyaljide uyu\u015fma ve g\u00fc\u00e7s\u00fczl\u00fck nadirdir. <\/li>\n\n\n\n<li class=\"\"><a href=\"https:\/\/www.niams.nih.gov\/health-topics\/raynauds-phenomenon\" target=\"_blank\" rel=\"noopener\">Raynaud hastal\u0131\u011f\u0131<\/a>, arterleri etkileyen ve ilerleyici daralmaya yol a\u00e7an kronik bir durumdur. Sonu\u00e7 olarak, hastalar\u0131n kollar\u0131nda ve ellerinde so\u011fuk intolerans\u0131 ve iskemi geli\u015fir. Parmak u\u00e7lar\u0131 \u00f6zellikle etkilenir. TOS ile Raynaud fenomeni aras\u0131ndaki temel fark, sinir hasar\u0131 ve ven\u00f6z t\u0131kan\u0131kl\u0131k gibi torasik outlet ile ilgili di\u011fer semptomlar\u0131n olmamas\u0131d\u0131r. Ayr\u0131ca, tan\u0131sal a\u00e7\u0131dan bak\u0131ld\u0131\u011f\u0131nda, Raynaud hastal\u0131\u011f\u0131nda anjiyografi kol, el ve parmak arterlerinde daralma g\u00f6sterirken, arteriyel TOS&#8217;ta sadece subklavyen arter 1. kaburgan\u0131n \u00fczerinde d\u0131\u015far\u0131dan bask\u0131y\u0131 tespit eder. <\/li>\n\n\n\n<li class=\"\"><a href=\"https:\/\/rarediseases.org\/rare-diseases\/parsonage-turner-syndrome\/\" target=\"_blank\" rel=\"noopener\">Parsonage-Turner Sendromu<\/a>, brakiyal pleksusu etkileyen son derece nadir bir hastal\u0131kt\u0131r. Akut bir ba\u015flang\u0131c\u0131 vard\u0131r ve a\u011fr\u0131 dayan\u0131lmazd\u0131r. A\u011fr\u0131dan sonra kolda \u015fiddetli g\u00fc\u00e7s\u00fczl\u00fck geli\u015fir. \u0130yile\u015ftikten sonra, hastalarda genellikle kol ve el kaslar\u0131nda kal\u0131c\u0131 <a href=\"https:\/\/www.healthline.com\/health\/paresis\" target=\"_blank\" rel=\"noopener\">parezi<\/a> geli\u015fir. PTS ve TOS aras\u0131ndaki temel farklar akut ba\u015flang\u0131\u00e7, \u015fiddet, iyile\u015fme sonras\u0131 a\u011fr\u0131n\u0131n olmamas\u0131 ve vask\u00fcler tutulumun olmamas\u0131d\u0131r. <\/li>\n\n\n\n<li class=\"\"><a href=\"https:\/\/www.ninds.nih.gov\/health-information\/disorders\/complex-regional-pain-syndrome\" target=\"_blank\" rel=\"noopener\">Kompleks b\u00f6lgesel a\u011fr\u0131 sendromlar\u0131<\/a>. \u0130ki tip KBAS vard\u0131r. Tip 1 daha \u00f6nce refleks sempatik distrofi olarak bilinir ve daha s\u0131k g\u00f6r\u00fcl\u00fcr. Tip 2&#8217;ye eskiden kozalji olarak biliniyordu. Bunlar, hastalar\u0131n ya\u015fam kalitesini \u00f6nemli \u00f6l\u00e7\u00fcde etkileyen olduk\u00e7a y\u0131prat\u0131c\u0131 sendromlard\u0131r. KBAS travma, k\u0131r\u0131k veya ameliyat gibi nispeten k\u00fc\u00e7\u00fck yaralanmalardan sonra geli\u015fir. Zamanla a\u011fr\u0131n\u0131n yo\u011funlu\u011fu ilk yaralanmay\u0131 a\u015far ve di\u011fer b\u00f6lgelere yay\u0131l\u0131r. Genellikle eller, kollar, ayaklar ve bacaklar etkilenir. A\u011fr\u0131 derecesi orijinal yaralanmayla orant\u0131s\u0131zd\u0131r ve ek semptomlar vard\u0131r. Otonom sinir sistemi s\u0131kl\u0131kla tutulur (eski ad\u0131 refleks sempatik distrofi). \u015ei\u015fme, k\u0131zar\u0131kl\u0131k, so\u011fukluk, terleme ataklar\u0131 olabilir. Kronik enflamasyon tipiktir ve ba\u011f\u0131\u015f\u0131kl\u0131k sistemi tutulumuna dair kan\u0131tlar da vard\u0131r. KBAS tipleri aras\u0131ndaki fark, tip 2&#8217;de periferik sinir hasar\u0131n\u0131n varl\u0131\u011f\u0131d\u0131r. <\/li>\n<\/ol>\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/kamranaghayev.com\/tr\/torasik-outlet-sendromu-teshisi\/\">Torasik \u00e7\u0131k\u0131\u015f sendromu tan\u0131s\u0131<\/a> klinik olarak konur ve radyografik do\u011frulama her zaman g\u00fcvenilir de\u011fildir. Yanl\u0131\u015f te\u015fhisler \u00e7ok s\u0131k g\u00f6r\u00fcl\u00fcr ve k\u00f6t\u00fc sonu\u00e7lar do\u011furabilir. Ba\u015far\u0131ya giden yolda \u00f6nemli bir ad\u0131m, deneyimli bir uzman taraf\u0131ndan yap\u0131lan kapsaml\u0131 bir de\u011ferlendirmedir.<\/p>\n\n<h3 class=\"wp-block-heading\" id=\"h-poor-surgical-technique\">Ameliyattan sonra kalan bas\u0131<\/h3>\n\n<p class=\"wp-block-paragraph\">Ameliyat sinirlerin ve damarlar\u0131n bas\u0131s\u0131n\u0131 kald\u0131rmay\u0131 ama\u00e7lar ve torasik outlet dekompresyonu (TOD) olarak adland\u0131r\u0131l\u0131r. Ameliyattan sonra \u015fik\u00e2yetler h\u00e2l\u00e2 s\u00fcren bir bas\u0131dan, sinirlerin \u00e7evresindeki nedbe dokusundan, ba\u015fka bir hastal\u0131ktan ya da yava\u015f veya eksik iyile\u015fen sinir hasar\u0131ndan kaynaklanabilir. Kalan bas\u0131, yerinde b\u0131rak\u0131lm\u0131\u015f ya da k\u0131smen \u00e7\u0131kar\u0131lm\u0131\u015f bir birinci kaburgay\u0131 ve kalan kas ya da fibr\u00f6z bantlar\u0131 i\u00e7erebilir. Yeniden ameliyat i\u00e7in sevk edilen hastalar \u00fczerine yap\u0131lan \u00e7al\u0131\u015fmalar bu se\u00e7ilmi\u015f grupta bulunanlar\u0131 anlat\u0131r; her t\u00fcr ilk ameliyat\u0131n ne s\u0131kl\u0131kla ba\u015far\u0131s\u0131z oldu\u011funu g\u00f6stermez.<sup><a href=\"#footnote_1_2798\" id=\"identifier_1_2798\" class=\"footnote-link footnote-identifier-link\" title=\"Jammeh ML, Ohman JW, Vemuri C, et al. Anatomically Complete Supraclavicular Reoperation for Recurrent Neurogenic Thoracic Outlet Syndrome: Clinical Characteristics, Operative Findings, and Long-term Outcomes. Hand (N Y). 2022;17(6): 1055-1064. https:\/\/doi.org\/10.1177\/1558944720988079\">1<\/a><\/sup><\/p>\n\n<h3 class=\"wp-block-heading\" id=\"h-scalenectomy-and-neurolysis-without-rib-resection\">Kaburga rezeksiyonu olmadan skalenektomi ve n\u00f6roliz<\/h3>\n\n<p class=\"wp-block-paragraph\">Tarihsel olarak, birinci kaburga rezeksiyonu torasik \u00e7\u0131k\u0131\u015f sendromu i\u00e7in ilk tedaviydi. Bununla birlikte, birinci ve ek kaburgalar\u0131n \u00e7\u0131kar\u0131lmas\u0131yla ili\u015fkili komplikasyon ve teknik zorluklar, 1920&#8217;lerde 1. kaburga \u00e7\u0131karmadan alternatif y\u00f6ntem \u00f6nerilmesine yol a\u00e7m\u0131\u015ft\u0131r.<sup><a href=\"#footnote_2_2798\" id=\"identifier_2_2798\" class=\"footnote-link footnote-identifier-link\" title=\"Adson AW, Coffey JR. Cervical Rib: A Method of Anterior Approach for Relief of Symptoms by Division of the Scalenus Anticus. Ann Surg. 1927;85(6): 839-857. https:\/\/doi.org\/10.1097\/00000658-192785060-00005\">2<\/a><\/sup>  Teknik \u00e7o\u011funlukla de\u011fi\u015fmemi\u015ftir ve bug\u00fcn hala kullan\u0131lmaktad\u0131r. \u00d6n ve orta skalen kaslar k\u0131smen \u00e7\u0131kar\u0131l\u0131r ve n\u00f6ro-vask\u00fcler demet bask\u0131 yapan yumu\u015fak doku bantlar\u0131ndan kurtar\u0131l\u0131r. Yakla\u015f\u0131m basitli\u011fi ve daha d\u00fc\u015f\u00fck riski nedeniyle yayg\u0131nla\u015ft\u0131. 1940&#8217;lar ile 1960&#8217;lar aras\u0131nda pek \u00e7ok cerrah hayal k\u0131r\u0131kl\u0131\u011f\u0131 yaratan sonu\u00e7lar bildirdi ve kaburga \u00e7\u0131karmaya geri d\u00f6nd\u00fc.<sup><a href=\"#footnote_3_2798\" id=\"identifier_3_2798\" class=\"footnote-link footnote-identifier-link\" title=\"Clagett OT. Research and prosearch. J Thorac Cardiovasc Surg. 1962;44: 153-66. https:\/\/pubmed.ncbi.nlm.nih.gov\/13879636\/\">3<\/a><\/sup><sup>, <\/sup><sup><a href=\"#footnote_4_2798\" id=\"identifier_4_2798\" class=\"footnote-link footnote-identifier-link\" title=\"Raaf J. Surgery for cervical rib and scalenus anticus syndrome. J Am Med Assoc. 1955;157(3): 219-223. https:\/\/doi.org\/10.1001\/jama.1955.02950200017005\">4<\/a><\/sup><\/p>\n\n<p class=\"wp-block-paragraph\">2005 y\u0131l\u0131nda yap\u0131lan k\u00fc\u00e7\u00fck bir randomize \u00e7al\u0131\u015fma, transaksiller birinci kaburga rezeksiyonunun kar\u015f\u0131la\u015ft\u0131r\u0131lan kaburga koruyucu sinir serbestle\u015ftirme ameliyat\u0131ndan daha iyi sonu\u00e7 verdi\u011fini buldu.<sup><a href=\"#footnote_5_2798\" id=\"identifier_5_2798\" class=\"footnote-link footnote-identifier-link\" title=\"Sheth RN, Campbell JN. Surgical treatment of thoracic outlet syndrome: a randomized trial comparing two operations. J Neurosurg Spine. 2005;3(5): 355-363. https:\/\/doi.org\/10.3171\/spi.2005.3.5.0355\">5<\/a><\/sup> Daha yeni seriler se\u00e7ilmi\u015f kaburga koruyucu ameliyatlarla iyi sonu\u00e7lar bildiriyor ve yakla\u015f\u0131m kullan\u0131lmaya devam ediyor.<sup><a href=\"#footnote_6_2798\" id=\"identifier_6_2798\" class=\"footnote-link footnote-identifier-link\" title=\"Johansen K. Rib-sparing scalenectomy for neurogenic thoracic outlet syndrome: Early results. J Vasc Surg. 2021;73(6): 2059-2063. https:\/\/doi.org\/10.1016\/j.jvs.2020.12.052\">6<\/a><\/sup> Kaburga koruyucu bir ameliyattan sonra \u015fik\u00e2yetler s\u00fcrerse, yerinde b\u0131rak\u0131lan birinci kaburga yukar\u0131daki di\u011fer olas\u0131l\u0131klarla birlikte de\u011ferlendirilecek olas\u0131l\u0131klardan biridir.<\/p>\n\n<h3 class=\"wp-block-heading\" id=\"h-incomplete-first-rib-removal\">K\u0131smi birinci kaburga \u00e7\u0131kar\u0131lmas\u0131<\/h3>\n\n<p class=\"wp-block-paragraph\">Birinci kaburga bas\u0131ya katk\u0131da bulunuyorsa, onu \u00e7\u0131karmak ameliyat\u0131n temel bir par\u00e7as\u0131d\u0131r ve kaburgan\u0131n ne kadar\u0131n\u0131n \u00e7\u0131kar\u0131ld\u0131\u011f\u0131 cerrahlara ve yakla\u015f\u0131mlara g\u00f6re de\u011fi\u015fir.<\/p>\n\n<p class=\"wp-block-paragraph\">\u00c7o\u011funlukla TOD ameliyat\u0131 boynun \u00f6n taraf\u0131ndan (supraklavik\u00fcler yakla\u015f\u0131m) yada koltuk alt\u0131ndan (transaksiller yakla\u015f\u0131m) ger\u00e7ekle\u015ftirilir. Ancak, bu yakla\u015f\u0131mlarla birinci ve aksesuar kaburgalar\u0131 tamamen \u00e7\u0131karmak teknik olarak zor ve risklidir. Bunun nedeni birinci kaburgan\u0131n anatomik konumudur. Birinci kaburgan\u0131n arkada omurga ve \u00f6nde sternum olmak \u00fczere, iki eklem ba\u011flant\u0131s\u0131 vard\u0131r. Birinci kaburgan\u0131n arka ve \u00f6n b\u00f6lgeleri \u00e7ok derindir ve eri\u015filmesi zordur.  <\/p>\n\n<p class=\"wp-block-paragraph\">Anatomik olarak brakiyal pleksus, subklavyen ven ve subklavyen arter birinci kaburgan\u0131n \u00fczerinden ge\u00e7er. Bunlar her ne pahas\u0131na olursa olsun korunmas\u0131 gereken hassas yap\u0131lard\u0131r. Ancak birinci kaburgaya eri\u015febilmek i\u00e7in bu sinir ve damarlar\u0131n hareket ettirilmesi gerekir. Birinci kaburga gibi, aksesuar servikal kaburgan\u0131n da omurga ile ya eklem ya da kemik ba\u011flant\u0131s\u0131 vard\u0131r. Brakiyal pleksusa yak\u0131nl\u0131k, aksesuar kaburga i\u00e7in birinci kaburgadan daha fazlad\u0131r, bu da g\u00fcvenli pozlamay\u0131 ve tamamen \u00e7\u0131karmay\u0131 zorla\u015ft\u0131r\u0131r. Bu nedenle cerrahlar bu zay\u0131f, hayati yap\u0131lar\u0131 riske atmamay\u0131 tercih ediyor ve derin b\u00f6l\u00fcmlere dokunulmuyor.<\/p>\n\n<p class=\"wp-block-paragraph\">Birinci kaburgan\u0131n orta b\u00f6l\u00fcm\u00fcne ve servikal kaburgan\u0131n ucuna ula\u015fmak daha kolay ve g\u00fcvenlidir; bu nedenle bu yakla\u015f\u0131mlarla kaburgan\u0131n \u00f6n ya da arka u\u00e7lar\u0131 yerinde kalabilir.<\/p>\n\n<figure class=\"wp-block-image aligncenter size-full\"><img decoding=\"async\" src=\"https:\/\/kamranaghayev.com\/wp-content\/uploads\/2024\/01\/residuals-ezgif.com-crop-e1741017451268.webp\" alt=\"Tekrarlayan Torasik Outlet Sendromu i&#xE7;in bir neden: rezid&#xFC;el kemik k&#xFC;t&#xFC;kleri ile tamamlanmam&#x131;&#x15F; birinci kaburga rezeksiyonu.\" class=\"wp-image-3650\"\/><figcaption class=\"wp-element-caption\"><em>Ameliyattan sonra kalan birinci kaburga kemi\u011fine bir \u00f6rnek. Klinik \u00f6nemi \u015fik\u00e2yetler, muayene ve ameliyat \u00f6yk\u00fcs\u00fcyle birlikte de\u011ferlendirilmelidir.<\/em><\/figcaption><\/figure>\n\n<p class=\"wp-block-paragraph\">Kalan bir kaburga baz\u0131 hastalarda bas\u0131n\u0131n s\u00fcrmesine katk\u0131da bulunabilir: bir \u00e7al\u0131\u015fmada geride kaburga kalan ve \u015fik\u00e2yetleri tekrarlayan hastalar, kaburgan\u0131n \u00e7\u0131kar\u0131ld\u0131\u011f\u0131 yeni bir ameliyattan sonra d\u00fczeldi.<sup><a href=\"#footnote_7_2798\" id=\"identifier_7_2798\" class=\"footnote-link footnote-identifier-link\" title=\"Likes K, Dapash T, Rochlin DH, Freischlag JA. Remaining or residual first ribs are the cause of recurrent thoracic outlet syndrome. Ann Vasc Surg. 2014;28(4): 939-945. https:\/\/doi.org\/10.1016\/j.avsg.2013.12.010\">7<\/a><\/sup> Ancak varl\u0131\u011f\u0131 ya da boyu tek ba\u015f\u0131na \u015fik\u00e2yetlerin nedenini g\u00f6stermez; uzun s\u00fcreli bir takipte kalan kaburgan\u0131n uzunlu\u011fu hastalar\u0131n on y\u0131l sonraki durumuyla ili\u015fkili bulunmad\u0131.<sup><a href=\"#footnote_8_2798\" id=\"identifier_8_2798\" class=\"footnote-link footnote-identifier-link\" title=\"Nuutinen H, K&auml;rkk&auml;inen JM, M&auml;kinen K, et al. Long-term outcome over a decade after first rib resection for neurogenic thoracic outlet syndrome. Interact Cardiovasc Thorac Surg. 2021;33(5): 734-740. https:\/\/doi.org\/10.1093\/icvts\/ivab172\">8<\/a><\/sup> Baz\u0131 hastalar ameliyattan sonra k\u00f6t\u00fcle\u015fir. Dr. Robert Leffert bunun olas\u0131 bir nedenini &#8220;eksik \u00fc\u00e7te bir&#8221; olarak tan\u0131mlad\u0131.<sup><a href=\"#footnote_9_2798\" id=\"identifier_9_2798\" class=\"footnote-link footnote-identifier-link\" title=\"Leffert RD. Complications of surgery for thoracic outlet syndrome. Hand Clin. 2004;20(1): 91-98. https:\/\/doi.org\/10.1016\/s0749-0712(03)00084-2\">9<\/a><\/sup> Bu \u00f6nerilen mekanizmada, birinci kaburgan\u0131n yaln\u0131zca orta b\u00f6l\u00fcm\u00fc \u00e7\u0131kar\u0131ld\u0131\u011f\u0131nda brakiyal pleksus arka kaburga k\u00fct\u00fc\u011f\u00fcne, subklavyen ven de \u00f6n k\u00fct\u00fc\u011fe yap\u0131\u015fabilir. Ameliyattan sonra olu\u015fan nedbe dokusu sinirleri ve damarlar\u0131 kemi\u011fe sabitleyebilir; altta kemik kalmad\u0131\u011f\u0131 i\u00e7in genellikle a\u015fa\u011f\u0131 do\u011fru sarkan \u00e7evre dokular brakiyal pleksusu ve veni de a\u015fa\u011f\u0131 \u00e7ekebilir. Altta kaburga k\u00fct\u00fckleri ve hareketi k\u0131s\u0131tlayan nedbe varken bu yap\u0131lar gerilebilir. Bu olas\u0131 bir a\u00e7\u0131klamad\u0131r; her k\u0131smi kaburga \u00e7\u0131kar\u0131lmas\u0131ndan sonra olan bir \u015fey de\u011fildir.<\/p>\n\n<p class=\"wp-block-paragraph\">Ameliyattan sonra \u015fik\u00e2yetler s\u00fcrer ya da geri d\u00f6nerse, yeniden de\u011ferlendirme ilk ameliyat\u0131n neleri kapsad\u0131\u011f\u0131n\u0131 ve mevcut \u015fik\u00e2yetlerin kalan bas\u0131dan, nedbe dokusundan, ba\u015fka bir hastal\u0131ktan m\u0131 yoksa sinirin eksik iyile\u015fmesinden mi kaynakland\u0131\u011f\u0131n\u0131 ortaya koymal\u0131d\u0131r; ameliyat raporunu ve \u00f6nceki g\u00f6r\u00fcnt\u00fcleri getirin. Sonraki tedavi rehabilitasyon, \u015fik\u00e2yetlerin y\u00f6netimi ya da a\u00e7\u0131k bir cerrahi hedefi olan se\u00e7ilmi\u015f hastalarda revizyon dekompresyonu olabilir. Nedbe ve de\u011fi\u015fmi\u015f anatomi nedeniyle revizyon daha karma\u015f\u0131kt\u0131r; bu y\u00fczden bu konuda deneyimli cerrahlar\u0131n i\u015fidir ve olas\u0131 fayda ile riskleri ayr\u0131ca konu\u015fulmal\u0131d\u0131r. Anatomik olarak tam bir ameliyattan sonra bile baz\u0131 hastalarda \u015fik\u00e2yetler tekrarlar; sinirlerin \u00e7evresinde nedbe olan se\u00e7ilmi\u015f hastalar yeniden yap\u0131lan sinir serbestle\u015ftirmesinden sonra d\u00fczelmi\u015ftir.<sup><a href=\"#footnote_10_2798\" id=\"identifier_10_2798\" class=\"footnote-link footnote-identifier-link\" title=\"Jammeh ML, Yang A, Abuirqeba AA, et al. Reoperative Brachial Plexus Neurolysis After Previous Anatomically Complete Supraclavicular Decompression for Neurogenic Thoracic Outlet Syndrome: A 10-Year Single-Center Case Series. Oper Neurosurg (Hagerstown). 2022;23(2): 125-132. https:\/\/doi.org\/10.1227\/ons.0000000000000252\">10<\/a><\/sup> <a href=\"https:\/\/kamranaghayev.com\/tr\/birinci-kaburga-rezeksiyonu-tos\/\">birinci kaburga \u00e7\u0131kar\u0131lmas\u0131 ve dekompresyon plan\u0131n\u0131n tamam\u0131<\/a> yaz\u0131m\u0131z bir ameliyat\u0131n neleri giderebilece\u011fini ve neleri gideremeyece\u011fini anlat\u0131yor.<\/p>\n\n<h2 class=\"wp-block-heading\" id=\"h-next-pured-procedure-for-thoracic-outlet-syndrome\">Sonraki: <a href=\"https:\/\/kamranaghayev.com\/tr\/torasik-outlet-sendromu-pure-teknigi\/\">Torasik Outlet Sendromu i\u00e7in PURED Prosed\u00fcr\u00fc<\/a><\/h2>\n\n<h2 class=\"wp-block-heading\" id=\"h-references\">Kaynaklar<\/h2>\n<ol class=\"footnotes\"><li id=\"footnote_1_2798\" class=\"footnote\">Jammeh ML, Ohman JW, Vemuri C, et al. Anatomically Complete Supraclavicular Reoperation for Recurrent Neurogenic Thoracic Outlet Syndrome: Clinical Characteristics, Operative Findings, and Long-term Outcomes. <em>Hand (N Y).<\/em> 2022;17(6): 1055-1064. <a href=\"https:\/\/doi.org\/10.1177\/1558944720988079\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1177\/1558944720988079<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_1_2798\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_2_2798\" class=\"footnote\">Adson AW, Coffey JR. Cervical Rib: A Method of Anterior Approach for Relief of Symptoms by Division of the Scalenus Anticus. <em>Ann Surg.<\/em> 1927;85(6): 839-857. <a href=\"\">https:\/\/doi.org\/10.1097\/00000658-192785060-00005<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_2_2798\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_3_2798\" class=\"footnote\">Clagett OT. Research and prosearch. J Thorac Cardiovasc Surg. 1962;44: 153-66. <a href=\"\">https:\/\/pubmed.ncbi.nlm.nih.gov\/13879636\/<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_3_2798\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_4_2798\" class=\"footnote\">Raaf J. Surgery for cervical rib and scalenus anticus syndrome. <em>J Am Med Assoc.<\/em> 1955;157(3): 219-223. <a href=\"https:\/\/doi.org\/10.1001\/jama.1955.02950200017005\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1001\/jama.1955.02950200017005<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_4_2798\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_5_2798\" class=\"footnote\">Sheth RN, Campbell JN. Surgical treatment of thoracic outlet syndrome: a randomized trial comparing two operations. <em>J Neurosurg Spine.<\/em> 2005;3(5): 355-363. <a href=\"\">https:\/\/doi.org\/10.3171\/spi.2005.3.5.0355<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_5_2798\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_6_2798\" class=\"footnote\">Johansen K. Rib-sparing scalenectomy for neurogenic thoracic outlet syndrome: Early results. <em>J Vasc Surg.<\/em> 2021;73(6): 2059-2063. <a href=\"https:\/\/doi.org\/10.1016\/j.jvs.2020.12.052\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1016\/j.jvs.2020.12.052<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_6_2798\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_7_2798\" class=\"footnote\">Likes K, Dapash T, Rochlin DH, Freischlag JA. Remaining or residual first ribs are the cause of recurrent thoracic outlet syndrome. <em>Ann Vasc Surg<\/em>. 2014;28(4): 939-945. <a href=\"\">https:\/\/doi.org\/10.1016\/j.avsg.2013.12.010<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_7_2798\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_8_2798\" class=\"footnote\">Nuutinen H, K\u00e4rkk\u00e4inen JM, M\u00e4kinen K, et al. Long-term outcome over a decade after first rib resection for neurogenic thoracic outlet syndrome. <em>Interact Cardiovasc Thorac Surg.<\/em> 2021;33(5): 734-740. <a href=\"https:\/\/doi.org\/10.1093\/icvts\/ivab172\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1093\/icvts\/ivab172<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_8_2798\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_9_2798\" class=\"footnote\">Leffert RD. Complications of surgery for thoracic outlet syndrome. <em>Hand Clin.<\/em> 2004;20(1): 91-98. <a href=\"\">https:\/\/doi.org\/10.1016\/s0749-0712(03)00084-2<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_9_2798\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_10_2798\" class=\"footnote\">Jammeh ML, Yang A, Abuirqeba AA, et al. Reoperative Brachial Plexus Neurolysis After Previous Anatomically Complete Supraclavicular Decompression for Neurogenic Thoracic Outlet Syndrome: A 10-Year Single-Center Case Series. <em>Oper Neurosurg (Hagerstown).<\/em> 2022;23(2): 125-132. <a href=\"https:\/\/doi.org\/10.1227\/ons.0000000000000252\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1227\/ons.0000000000000252<\/a><span class=\"footnote-back-link-wrapper\">[<a href=\"#identifier_10_2798\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><\/ol>","protected":false},"excerpt":{"rendered":"<p>Tekrarlayan Torasik Outlet Sendromu: Neden ortaya \u00e7\u0131kt\u0131\u011f\u0131n\u0131 anlay\u0131n ve mevcut tedavi y\u00f6ntemlerini ve stratejilerini ke\u015ffedin.<\/p>\n","protected":false},"author":2,"featured_media":3865,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","ka_reviewed_on":"","ka_updated_on":"","footnotes":""},"categories":[40,41],"tags":[],"class_list":["post-2798","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-tedaviler","category-torasik-cikis-sendromu-tos-tedavisi"],"acf":[],"_links":{"self":[{"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/posts\/2798","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/comments?post=2798"}],"version-history":[{"count":2,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/posts\/2798\/revisions"}],"predecessor-version":[{"id":7389,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/posts\/2798\/revisions\/7389"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/media\/3865"}],"wp:attachment":[{"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/media?parent=2798"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/categories?post=2798"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kamranaghayev.com\/tr\/wp-json\/wp\/v2\/tags?post=2798"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}