胸部小切口在胸心外科手术中的临床观察

目的探讨胸部小切口在胸心外科手术中的临床应用价值及疗效。方法在胸心外科手术中,运用腋下小切口52例,切口为7～13 cm;运用胸壁侧切口32例,切口为6～12 cm。结果 84例胸心外科行胸部小切口手术患者均顺利完成手术治疗,平均手术时间为（76±24）min,手术全程未再次输血,术后胸引时间为（4.1±1.3）d,术中、术后均无并发症发生,术后24 h后即可轻微活动手术上肢,伤口有轻微痛感。52例患者行腋下小切口手术治疗,术野暴露良好,平均11 cm×15 cm。患者术中出血均少于80 mL,其中37例患者出血量在30 mL以内,开胸时间为8～15 min,关胸时间为14～16 min,开、关胸手术时间均在16 min以内。32例患者胸壁侧切口手术,联合腹腔镜进行辅助手术,有11例患者关胸前充分鼓肺,肺膨胀效果好,未留置胸腔引流。结论胸部小切口手术术野暴露效果好,切口小,便于操作,对神经、血管、肌肉损伤小,瘢痕小,切口隐蔽,美观效果好,愈合快,值得在临床中推广

Clinical observation of thoracic small incision in cardiothoracic surgery

Objective To investigate the clinical value and efficacy of thoracic small incision in cardiothoracic surgery.Methods Subaxillary small incision of 7-13 cm was used in 52 cases and chest wall lateral incision of 6-12 cm was used in 32 cases for cardiothoracic surgery.Results All 84 cases of cardiothoracic surgery were successful with average operation time of(76±24) min.None blood transfusion was performed during all the procedure.And the postoperative thoracic drainage time was(4.1±1.3) days,with no intraoperative or postoperative complications.Patients recovered minor activity of the operated upper extremity 24 hours after surgery with slight wound pain.52 patients receiving subaxillary small incision had good average surgical field exposure of 11 cm×15 cm.Intraoperative bleeding of all the patients was less than 80 mL,and those of 37 patients were less than 30 mL.Average incision opening and closing time of the patients were 8-15 min and 14-16 min,which were both below 16 min.32 patients receiving chest wall lateral incision were given laparoscopic-assisted surgery.11 patients had good lung expansion of full drum lung before incision closure without subsequent indwelling pleural drainage.Conclusion Chest small incision has the advantage of good surgical field exposure,small and concealed incision,ease of operation,minimum damage to nerve,blood vessel and muscle,minimum scar and rapid healing,thus is worthy of clinical application.