Akçali Yiğit, Demir Hasan, Tezcan Bekir
Department of Thoracic and Cardiovascular Surgery, Erciyes University Medical Faculty, Kayseri, Turkey.
Ann Thorac Surg. 2003 Oct;76(4):1050-4. doi: 10.1016/s0003-4975(03)00565-4.
Different alternative approaches to thoracotomy have been developed because of the considerable morbidity associated with the standard posterolateral incision.
We studied a prospective, randomized, blinded study of 60 consecutive patients to compare surgical approach time, postoperative pain (quantitated by narcotic requirements and the visual analogue scale), pulmonary function, shoulder strength, and range of motion between standard posterolateral (group I) and muscle-sparing (group II) thoracotomy techniques.
There were no differences in postoperative surgical time, pulmonary function, shoulder range of motion, mortality, or hospitalization time. There was significantly less postoperative pain in group II. In this group, narcotic requirement was less in the first 24 hours, and visual analogue scale scores were significantly lower (p < 0.05) throughout the first postoperative week. Muscle strength had returned to preoperative levels by 1 month in both groups. Morbidity was identical in the two groups with the exception of postoperative seromas. The prevalence of seroma was 16.6% in the muscle-sparing group.
We conclude that the muscle-sparing incision may be a sensible alternative to a standard posterolateral thoracotomy.
由于标准后外侧切口相关的较高发病率，已开发出不同的开胸替代方法。
我们对60例连续患者进行了一项前瞻性、随机、盲法研究，以比较标准后外侧开胸术（I组）和保留肌肉开胸术（II组）在手术入路时间、术后疼痛（通过麻醉需求和视觉模拟评分定量）、肺功能、肩部力量以及活动范围方面的差异。
术后手术时间、肺功能、肩部活动范围、死亡率或住院时间无差异。II组术后疼痛明显较轻。在该组中，术后24小时内麻醉需求较少，且术后第一周内视觉模拟评分显著较低（p < 0.05）。两组患者的肌肉力量在1个月时均恢复到术前水平。除术后血清肿外，两组的发病率相同。保留肌肉组血清肿的发生率为16.6%。
我们得出结论，保留肌肉切口可能是标准后外侧开胸术的一种合理替代方法。
