正中小切口全胸骨劈开术治疗心脏疾病的手术策略及应用技巧

目的:探讨正中小切口全胸骨劈开术应用于多数心脏手术策略和实施技巧。方法:总结2017年11月至2019年12月复旦大学附属中山医院302例全胸骨劈开正中小切口心脏直视手术经验,与常规正中切口手术和右侧开胸微创手术的二尖瓣修复手术的手术效果、手术时间、主动脉阻断时间、出血量和ICU停留时间进行比较。结果:正中小切口手术将胸骨全切开,但将常规的20 cm切口长度缩小到6～8 cm,胸骨只撑开6 cm,可进行多数心脏手术,取得良好效果,适应证广,且具备微创手术切口小、美观的优点,对胸廓影响小,又具备正中开胸的心脏显露清楚,手术迅速确切,心脏中心插管,手术安全性高,不增加手术时间、主动脉阻断时间、出血量和ICU停留时间,不需要单肺通气等诸多优势。结论:正中小切口这种微创手术方式,适应证广泛,操作较方便,易于临床推广。

Surgical strategy and application skills of ministernotomy in the treatment of heart disease

Objective: To explore the strategies and implementation techniques of ministernotomy for most cardiac surgery.Methods: 302 patients of direct open-heart surgery with ministernotomy in Zhongshan Hospital, Fudan University from November 2017 to December 2019 were summarized, and compared with other minimally invasive heart surgery with surgical effection, operation time, aortic occlusion time, bleeding volume and ICU stay time.Results: The ministernotomy completely cuts the sternum, but reduces the length of the conventional incision from 20 cm to 6-8 cm, and the sternum is only 6 cm opened. It can perform most heart surgery with great results. It has a wide range of indications, smaller incisions and beautiful appearance, minimal impact on the thorax, and a heart with a mid-thoracotomy. The heart is clearly exposed, the operation is rapid and accurate, and no need for single lung ventilation.Conclusions: The ministernotomy has a wide range of indications and convenient operation, and it is especially easy to popularize.