Pick A, Dearani J, Odell J
Department of Cardiac Surgery, Mayo Medical Center, Rochester, Australia.
J Cardiovasc Surg (Torino). 1998 Oct;39(5):673-6.
Median sternotomy was performed by 2 different techniques in order to determine whether there was a difference in the incidence of inadvertent pleural entry.
Patients were prospectively evaluated and reviewed at a mean follow-up interval of 8.2 months.
Ninety five consecutive patients underwent primary sternotomy at a single tertiary referral center.
Planned outcome measures included, incidence of pleural entry, length of hospitalization, and chest tube site related postoperative morbidity.
Group 1 (n=49) had sternotomy undertaken from the sternal notch proceeding downwards. Group 2 (n=46) underwent sternotomy performed from the xiphoid upwards. Mediastinal evaluation revealed a significant reduction in the incidence of pleural violation for group 1 (3) versus group 2 (11) (p=0.014). This difference was not found to be surgeon specific.
Sternotomy undertaken from the sternal notch proceeding downwards is shown to be associated with a reduced incidence of inadvertent pleural entry. Potential advantages for this approach also include reduced respiratory morbidity, less chest tube site complications and a trend to reduced length of hospitalization.
采用两种不同技术进行正中胸骨切开术，以确定意外进入胸膜腔的发生率是否存在差异。
对患者进行前瞻性评估，并在平均8.2个月的随访期内进行复查。
95例连续患者在单一三级转诊中心接受初次胸骨切开术。
计划的结果指标包括胸膜进入的发生率、住院时间以及胸管置入部位相关的术后发病率。
第1组（n = 49）从胸骨切迹向下进行胸骨切开术。第2组（n = 46）从剑突向上进行胸骨切开术。纵隔评估显示，第1组（3例）与第2组（11例）相比，胸膜侵犯的发生率显著降低（p = 0.014）。未发现这种差异与外科医生有关。
从胸骨切迹向下进行胸骨切开术与意外进入胸膜腔的发生率降低有关。这种方法的潜在优势还包括降低呼吸系统发病率、减少胸管置入部位并发症以及住院时间有缩短趋势。
