Elshiekh Mohamed A F, Lo Tammy T H, Shipolini Alex R, McCormack David J
Department of Cardiothoracic Surgery, Suez Canal University Hospital, Ismailia, Egypt.
Interact Cardiovasc Thorac Surg. 2013 Jan;16(1):60-7. doi: 10.1093/icvts/ivs295. Epub 2012 Oct 9.
A best evidence topic was written according to a structured protocol. The question addressed was whether muscle-sparing thoracotomy (MST), as opposed to posterolateral thoracotomy (PLT), results in better recovery. A total of 108 papers were found using the reported searches of which eight represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. A recent large prospective, randomized, double-blinded, controlled study demonstrated a shorter length of stay in patients undergoing MST. It failed to demonstrate any significant difference in pain reported or pulmonary function. A separate prospective randomized controlled trial focussed on pain, pulmonary function, late shoulder range of motion and late muscle strength. It failed to show any significant difference in these domains between PLT and MST. While the mean 'opening time' is greater when performing a MST, this is negated by a shorter mean 'closing time' when compared with PLT. Overall, the evidence suggests that MST results in greater early (1 week) preservation of skeletal muscle strength and range of motion over PLT. This difference has disappeared at 1 month. There is little evidence to suggest a difference in pulmonary function or pain dependent on the thoracotomy type. Moreover, analgesic consumption is similar. However, there is an inverse relationship between the incision length and the post-thoracotomy syndrome.
根据结构化方案撰写了一个最佳证据主题。所探讨的问题是，与后外侧开胸术（PLT）相比，保留肌肉开胸术（MST）是否能带来更好的恢复效果。通过报告的检索共找到108篇论文，其中8篇代表了回答该临床问题的最佳证据。现将作者、日期、期刊、研究类型、人群、主要结局指标和结果制成表格列出。最近一项大型前瞻性、随机、双盲对照研究表明，接受MST的患者住院时间更短。但该研究未能证明在疼痛报告或肺功能方面存在任何显著差异。另一项前瞻性随机对照试验聚焦于疼痛、肺功能、后期肩部活动范围和后期肌肉力量。该试验未能显示PLT和MST在这些方面存在任何显著差异。虽然进行MST时平均“打开时间”更长，但与PLT相比，其平均“关闭时间”更短，从而抵消了这一差异。总体而言，证据表明，与PLT相比，MST能在早期（1周）更好地保留骨骼肌力量和活动范围。这种差异在1个月时消失。几乎没有证据表明肺功能或疼痛因开胸术类型而异。此外，镇痛药物的消耗量相似。然而，切口长度与开胸术后综合征之间存在反比关系。
