Wang Wen Lin, Cai Kai Can, Zeng Wei Sheng, Jiang Ren Chao
Department of Cardiothoracic Surgery, Guangzhou General Military Hospital, China.
Med Sci Monit. 2003 Mar;9(3):CR109-13.
In order to reach a clear understanding of minimally invasive approaches in cardiac operations, the authors review clinical experience in using three such approaches: inferior partial median sternotomy, right anterolateral minor thoracotomy, and the right parasternal approach.
MATERIAL/METHODS: Sternotomy and the three different minimally invasive approaches were applied in and 2431 and 323 patients respectively. The approaches were selected according to the circumstances of the individual case. Both external and internal cardiac structures were observed during the operations. The length of the incision, the postoperative drainage, operative time, and cardiopulmonary bypass time were investigated. The postoperative complications occurring after minimally invasive approaches were observed.
In inferior partial median sternotomy, all structures except for the ascending aorta could be exposed well. In right anterolateral minor thoracotomy, only the structures on the right side of the heart could be exposed, but the mitral valve could also be exposed well. The exposure of the right parasternal approach was similar to that of right anterolateral minor thoracotomy. There were statistically significant differences between sternotomy and the minimally invasive approaches in terms of incision length and postoperative drainage, but no difference in operative time and cardiopulmonary bypass time. The postoperative complications of MIAs included air embolism (n = 3), chest pain (n = 9), chest wall malacia (n = 1), rib fracture (n = 2), and sternum fracture (n = 2). The total incidence of complications in minimally invasive approaches was 5.3%.
The minimally invasive approaches can have satisfactory clinical results if the approaches are correctly chosen and performed.
为了清晰了解心脏手术中的微创方法，作者回顾了使用三种此类方法的临床经验：下部分正中胸骨切开术、右前外侧小切口开胸术和右胸骨旁入路。
材料/方法：分别对2431例和323例患者应用了胸骨切开术和三种不同的微创方法。根据个案情况选择手术方法。手术过程中观察心脏的外部和内部结构。研究切口长度、术后引流、手术时间和体外循环时间。观察微创方法术后发生的并发症。
在下部分正中胸骨切开术中，除升主动脉外的所有结构均可良好暴露。在右前外侧小切口开胸术中，只能暴露心脏右侧的结构，但二尖瓣也可良好暴露。右胸骨旁入路的暴露情况与右前外侧小切口开胸术相似。胸骨切开术与微创方法在切口长度和术后引流方面存在统计学显著差异，但手术时间和体外循环时间无差异。微创方法的术后并发症包括空气栓塞（n = 3）、胸痛（n = 9）、胸壁软化（n = 1）、肋骨骨折（n = 2）和胸骨骨折（n = 2）。微创方法的并发症总发生率为5.3%。
如果正确选择并实施微创方法，可取得满意的临床效果。
