Hayward R H, Knight W L, Baisden C E, Korompai F L
Department of Surgery, Texas A&M University College of Medicine, Temple.
J Am Coll Surg. 1994 Aug;179(2):202-8.
For years the standard access to the thorax has been by posterolateral or other muscle cutting thoracotomy incisions. These are accompanied by significant discomfort and often limitation of shoulder girdle movement. To obviate these distressing features, the less traumatic median sternotomy was recommended. In the last ten years, several types of mini or axillary thoracotomies have been described. We believe that the vertical axillary thoracotomy is the best of these incisions as no major muscles are divided, it can be created rapidly, and exposure is excellent.
We compared the operative approaches from the point of view of the duration of postoperative hospitalization, the length of the operating time, the incidence of postoperative atelectasis, and persistence of incisional pain.
The vertical axillary thoracotomy showed a definite advantage in all these categories.
These findings suggest that the vertical axillary thoracotomy is the incision of choice for most thoracic procedures as the incision is small and quickly made. Because there is limited division of muscles, the convalescence is smooth and uncomplicated.
多年来，进入胸腔的标准方法一直是后外侧或其他切断肌肉的开胸切口。这些切口会带来明显的不适，并且常常限制肩带活动。为了避免这些令人痛苦的特征，有人推荐采用创伤较小的正中胸骨切开术。在过去十年中，已经描述了几种类型的小切口或腋下开胸术。我们认为垂直腋下开胸术是这些切口中最好的，因为它不切断主要肌肉，能够快速完成，并且显露良好。
我们从术后住院时间、手术时间长度、术后肺不张发生率以及切口疼痛持续时间的角度比较了手术方法。
垂直腋下开胸术在所有这些方面都显示出明显优势。
这些发现表明，垂直腋下开胸术是大多数胸部手术的首选切口，因为切口小且能快速完成。由于肌肉切断有限，恢复过程顺利且无并发症。
