小切口开胸术38例报告

目的探讨小切口开胸术的可行性。方法腋下第5、6、7肋间小切口（切口长8．5～13．5cm），后推背阔肌，沿肌纤维方向切开前锯肌，两肋间正中或肋骨上缘切开肋间肌及胸膜，切除肺良恶性病变38例。结果38例均在小切口下完成手术，其中17例肺叶楔形切除，1例肺隔离症叶外型病灶切除，18例肺叶切除，1例右肺中下叶切除，1例左全肺切除。手术时间50～150min，平均96min；术中出血量100～400ml，平均220ml。无术中并发症；术后1例胸腔积液，穿刺抽液后复查吸收。结论小切口开胸术暴露充分，创伤小，可行。二次手术、胸膜广泛粘连及肿瘤侵犯胸壁，不宜小切口开胸。

Mini-incision muscle-sparing thoracotomy for pulmonary diseases: Report of 38 cases

Objective To investigate the feasibility of mini-incision muscle-sparing thoracotomy for pulmonary diseases. Methods The operation was performed through a subaxillary mini-incision along the 5th,6th,or 7th intercostals space and 8.5~13.5 cm in length.The latissimus dorsi muscle was pressed backwards,and the serratus anterior muscle was opened along the direction of muscle fibres.The intercostal muscles and the pleura were cut through along the midline between the two adjacent ribs or the superior border of the rib,for the resection of pulmonary benign or malignant lesions.Results The operation was successfully accomplished via mini-incision thoracotomy in all the 38 cases,including 17 cases of wedge resection,1 case of lesion resection of pulmonary sequestration,18 cases of lobectomy,1 case of lower right lobectomy,and 1 case of left total pneumonectomy.The duration of procedure was 50~150 min(mean,96 min),and the intraoperative blood loss was 100~400 ml(mean,220 ml).No complications were seen.Pleural effusion developed in 1 case postoperatively,and then subsided after drawing-off of fluid.Conclusions The mini-incision muscle-sparing thoracotomy has advantages of clear exposure and minimal invasion.But this procedure is not advisable in patients scheduled for a re-operation or with extensive pleural adhesion or tumor involvement to the chest wall.