Mayfield W R
Peachtree Cardiovascular and Thoracic Surgeons, 95 Collier Road, Suite 2055, Atlanta, GA 30309, USA.
Heart Surg Forum. 1998;1(1):26-9.
Repeat cardiac surgery represents eight to twenty five percent of cardiac surgical procedures. Catastrophic hemorrhage is a known complication of repeat sternotomy. A number of techniques have been described to reduce the incidence of injury to the heart and mediastinal structures during reoperation. This paper reports a new endoscopic technique to visualize and lyse the adhesions between the sternum and heart prior to repeat median sternotomy.
A unique substernal retractor and endoscopic visualization system was developed specifically to facilitate safe and rapid sternotomy in reoperative cardiac cases. Twenty-four patients underwent elective reoperation using the Endoscopic Redo Sternotomy Retractor and instrumentation. There were 5 patients with prior valve surgery and 19 patients with coronary bypass grafts in place. Retrosternal adhesions were divided with special endoscopic cautery or scissors after which a standard reciprocating saw was used to open the sternum without damage to underlying structures.
The time required for endoscopic dissection of retrosternal adhesions ranged from 6 to 22 minutes. No injury to any cardiac structure or conduit occurred.
The Endoscopic Redo Sternotomy Retractor provides excellent visualization of all retrosternal structures and adhesions allowing safe and meticulous dissection prior to sternal opening.
再次心脏手术占心脏外科手术的8%至25%。灾难性出血是再次开胸手术已知的并发症。已经描述了多种技术来降低再次手术期间心脏和纵隔结构损伤的发生率。本文报道了一种新的内镜技术，用于在再次正中开胸术前可视化并溶解胸骨与心脏之间的粘连。
专门开发了一种独特的胸骨后牵开器和内镜可视化系统，以促进再次心脏手术中安全、快速地开胸。24例患者使用内镜再次开胸牵开器及器械接受了择期再次手术。其中5例曾接受瓣膜手术，19例已行冠状动脉搭桥术。用特殊的内镜电灼器或剪刀分离胸骨后粘连，然后使用标准往复锯打开胸骨，而不损伤其下方结构。
内镜下分离胸骨后粘连所需时间为6至22分钟。未发生对任何心脏结构或血管的损伤。
内镜再次开胸牵开器能很好地可视化所有胸骨后结构和粘连，便于在胸骨切开术前进行安全、细致的分离。
