Van Raemdonck D, Coosemans W, Lerut T
Department of Surgery, University Hospitals Leuven, Belgium.
Acta Chir Belg. 1993 Sep-Oct;93(5):207-11.
A standard posterolateral thoracotomy with division of the latissimus dorsi and serratus anterior muscles is associated with an important postoperative morbidity. A vertical axillary thoracotomy combining a vertical axillary skin incision with an intermuscular approach sparing both latissimus dorsi and serratus anterior muscles has the advantage of allowing full shoulder girdle motion early postoperatively as well as masking of the scar by the upper arm at rest. We report our experience with nine patients operated on with this approach for various intrathoracic lesions. All procedures were carried out without major difficulties. Wound healing was excellent in all patients. No infection nor seroma formation was seen with a submuscular suction drain. All patients had early and full shoulder girdle movement. No patient complained of late post-thoracotomy pain. We conclude that a vertical axillary thoracotomy provides an excellent cosmetic and muscle sparing incision which can be utilized for many thoracic procedures. However, we believe that, in the near future, video-assisted thoracoscopic surgery will become more popular than open thoracotomy for certain indications because of its distinct advantages of less postoperative morbidity.
标准后外侧开胸术需切断背阔肌和前锯肌，术后会有较高的并发症发生率。垂直腋下开胸术采用垂直腋下皮肤切口并经肌间隙入路，可保留背阔肌和前锯肌，术后早期即可实现肩带的充分活动，上臂静止时还可掩盖手术瘢痕。我们报告了9例采用该方法治疗各种胸内病变患者的经验。所有手术均顺利完成，无重大困难。所有患者伤口愈合良好，肌下负压引流未出现感染或血清肿形成。所有患者肩带均能早期且充分活动，无患者主诉开胸术后晚期疼痛。我们得出结论，垂直腋下开胸术提供了一个美观且保留肌肉的切口，可用于多种胸部手术。然而，我们认为，在不久的将来，对于某些适应证，电视辅助胸腔镜手术因其术后并发症较少的明显优势，将比开胸手术更受欢迎。
