Normandin L, Pagé A, Verdant A
Département de chirurgie, Université de Montréal, Québec, Canada.
Ann Chir. 1991;45(9):760-3.
Muscle sparing thoracotomy is suggested more frequently in recent literature. From March 1988 to February 1990, a muscle sparing technique was used in 77 (58%) of 132 consecutive thoracotomies. There were 50 men and 27 women, age varied from 23 to 81 years, with a mean of 58 years. Forty-four lobectomies, 10 pneumonectomies, 9 lung biopsies, 6 wedge resections, 6 bullectomies and 2 segmentectomies were performed. A horizontal incision was used in 47 (61%) patients and a vertical mid-axillary incision in 30 (39%). For optimal exposure, transection of the latissimus dorsi muscle was needed in 14 (30%) of the horizontal incisions. Inadvertent rib fracture occurred in 10 (13%) cases. Continuous epidural analgesia was added in 46 (60%) patients for an average of 40 hours. Mechanical ventilation in 14 (18%) patients for a mean duration of 22 hours and an average stay of 2 days in the ICU and 7 days in the hospital, were required. There was 1 (1.3%) hospital mortality, 4 (5%) patients developed a seroma that required aspiration. Muscle sparing thoracotomy can be used safely for most thoracic procedures and we believe it permits easier pain control and early preservation of full shoulder motion. However the operative field is more restricted. A horizontal incision, permitting section of the latissimus dorsi for better exposure should be used for hilar or invasive lesions.
近期文献中更频繁地建议采用保留肌肉的开胸术。从1988年3月至1990年2月，在连续132例开胸手术中，77例（58%）采用了保留肌肉技术。其中男性50例，女性27例，年龄从23岁至81岁不等，平均年龄58岁。共进行了44例肺叶切除术、10例全肺切除术、9例肺活检、6例楔形切除术、6例肺大疱切除术和2例肺段切除术。47例（61%）患者采用水平切口，30例（39%）采用腋中线垂直切口。为了获得最佳暴露，14例（30%）水平切口需要切断背阔肌。10例（13%）发生了意外肋骨骨折。46例（60%）患者加用了连续硬膜外镇痛，平均时间为40小时。14例（18%）患者需要机械通气，平均持续时间为22小时，在重症监护病房平均停留2天，住院7天。有1例（1.3%）医院死亡，4例（5%）患者出现血清肿需要抽吸。保留肌肉的开胸术可安全用于大多数胸部手术，我们认为它能更轻松地控制疼痛并早期保留肩部的完全活动。然而，手术视野更受限。对于肺门或侵袭性病变，应采用允许切断背阔肌以获得更好暴露的水平切口。
