摘要
目的:Muscle-Sparing(MS)剖胸切口是当今流行的一种微创剖胸切口,有多种不同的操作方法,通过对传统MS切口、改良MS切口和听诊三角MS切口3种不同剖胸方法的比较,探讨其各自的临床适用范围。方法:1999年12月—2006年6月,应用上述3种MS剖胸切口共完成各种胸部手术327例,包括周围型肺癌191例,肺转移性肿瘤39例,肺部良性肿瘤64例,纵隔肿瘤10例,自发性气胸16例,食管平滑肌瘤7例。结果:全组无手术死亡病例,无术中、术后严重并发症。术后发生长时间漏气21例,伤口血肿7例。传统的MS切口开胸时间最短(平均10.5 min),术野面积最大(平均148cm^2),但从创伤和美观的角度来看不及另两种切口。改良的MS切口完整地保留了胸壁肌群,但为显露前锯肌后缘需大范围游离皮瓣及背阔肌,术中上胸部骨性胸廓显露较差,进胸时间最长(平均18.1 min),术野显露不及传统的MS切口。听诊三角MS切口则利用斜方肌与背阔肌、前锯肌之间的间隙进胸,其术野面积最小(平均87 cm^2)。结论:3种不同的MS切口均适用于肺楔形切除、肺大疱切除、胸膜固定等简单手术。其中传统MS切口术野显露最佳,可应用于上叶切除、全肺切除、食管平滑肌瘤摘除、纵隔肿瘤切除等相对复杂的手术。对于原发性肺癌,该切口可适用于大部分临床分期为Ⅰa至Ⅱb的病例以及部分Ⅲa期病例。改良的MS切口对于肺叶切除则限于下叶和中叶,对于原发性肺癌的治疗一般应限于临床分期为Ⅰ期的病例以及部分Ⅱ期病例。听诊三角MS切口因术野较小,即便行肺楔形切除术,也应选择病变位于切口附近的病例,对于原发性肺癌仅限于少数临床分期为Ⅰ期的病例,还适用于简单的后上纵隔肿瘤切除术。只要掌握各种切口特点,合理选择病例并恰当使用一次性手术器械,MS剖胸切口是一种安全可行的微创剖胸切口。
Objective： As a minimal invasive procedure, muscle-sparing thoracotomy is now widely used. Many authors reported several different techniques of incision. We divided them into three different procedures according to the anatomy of the thoracic muscles. They were traditional muscle-sparing thoracotomy, modified muscle-sparing thoracotomy and auscultatory triangle muscle-sparing thoracotomy. The purpose of the study is to compare and explore the clinical feasibility and advantages of the three different kinds of muscle-sparing thoracotomy according to our knowledge. Methods： We performed above three different kinds of muscle-sparing thoracotomy totally in 327 cases from December 1999. Among them, there were 191 cases of peripheral primary lung cancer, 39 cases of metastatic lung carcinoma, 64 cases of benign lung nodule, 10 cases of mediastinal neoplasm, 16 cases of spontaneous pneumothorax and 7 cases of esophageal leiomyoma. Results： There were no operative death occurred, no serious complications Occurred during or after the procedure. We had 21 cases of long postoperative air leakage, 7 cases of hematoma of wou＇nd. The mean opening time （about 10.5 min） was shortest and the spreading area of the intercostal space （about 148 cm^2 ） was largest in traditional muscle-sparing thoracotomy. But it is inferior to the other two kinds of musclesparing incisions according to its traumatic and cosmetic results. The whole thoracic muscles were preserved in modified muscle-sparing thoracotomy. But the subcutaneous tissue and latissimus dorsi should be mobilized widely to expose the postero-inferior border of serratus anterior, however, the exposure of the upper side of the thoracic rib cage was still inadequate, the mean opening time （about 18.1 min） was longest, and the spreading area of the intercostal space was smaller than which in traditional muscle-sparing thoracotomy. The spreading area was the smallest （about 87 cm^2 ） in auscultatory triangle muscle-sparing thoracotomy. Conclusion：We there
出处
《中国临床医学》
北大核心
2007年第6期792-794,共3页
Chinese Journal of Clinical Medicine
