胸骨旁“门式切口”的应用解剖学研究

目的:通过应用解剖学的方法对胸骨旁“门式切口”的可行性进行研究。方法:对10具尸体前胸壁深层结构的血供规律、胸廓内动脉的分支、走行特点进行观察,测量胸骨外侧缘与胸廓内动脉之间的距离。在此基础上,设计出含有复合组织瓣的胸骨旁“门式切口”,并对其可行性进行分析。结果:前胸壁深层各结构均由胸廓内动脉及其分支供血,胸廓内动脉距胸骨外侧缘的距离为1cm左右,紧挨胸骨外侧缘切开肋软骨,可以避免胸廓内动脉的损伤。根据这些特点,可于胸骨旁设计出数种“门式切口”。右侧胸骨旁“门式切口”对心脏右侧诸结构显露良好,对升主动脉也可以良好显露,可用来完成数种心脏手术。结论:胸骨旁“门式切口”是一种较为实用的手术切口,具有切口隐蔽、长度短、不需要强大牵引等优点,是一种可行的微创手术切口。

Applied anatomical study on parasternal door approach

Objective To study the feasibility of parasternal door approach with an applied anatomical researching method, Methods The studies were carded out on ten cadavers, The blood supplying characteristics of the structures on deeper layers of the anterior thoracic wall were studied, The distributing regularity of internal thoracic artery was observed. The distance between internal thoracic artery and the lateral edge of sternum was measured in every intercostal space. Based on these anatomical characteristics, the novel approaches, parasternal door approach containing complicated tissue flap for cardiac operations was designed. Results The internal thoracic artery and its branches were the main nutrient artery for the structures of the deeper layers of anterior thoracic wall. The distance between the sternum and the internal thoracic artery was about 1 cm, which was wide enough for incising these two structures without injuring the internal thoracic artery, According to these characteristics, several parastemal door approaches could be designed, Right parasteral door approach could expose the structures on the right part of heart and ascending aorta satisfactorily, therefore several cardiac operations could be accomplished. Conclusion Parastemal door approach is a useful approach for cardiac operation, which has the advantages of invisible skin incision, short scar and less retraction. So it is a feasible minimally invasive approach for cardiac operations.