胸部小切口对肺动脉瓣的显露效果

目的:评价不同小切口对肺动脉瓣的显露效果。方法:在12具成人尸体上模拟上半部分胸骨劈开切口、下半部分胸骨劈开切口、右侧胸骨旁切口、左侧胸骨旁切口、右前外侧小切口、左前外侧小切口以及正中小切口。在各种小切口中经右心室流出道切口观察肺动脉瓣的显露效果。结果:上半部分胸骨劈开切口中,下缘至少要切到第3肋间才可理想显露肺动脉瓣。下半部分胸骨劈开切口中,切口上缘至少要到第3肋间水平。右侧胸骨旁切口和右前外侧小切口对肺动脉瓣显露不良。正中小切口中,第3、4肋间水平的切口效果理想。第3、4肋间的左侧胸骨旁切口和左前外侧小切口均可显露肺动脉瓣。结论:右侧的胸部小切口不适于肺动脉瓣的显露,正中部位小切口和左侧胸壁切口可显露房间隔,但左侧胸壁切口无法常规建立体外循环,因此,部分胸骨劈开切口和正中小切口是肺动脉瓣手术较为理想的入路。

Evaluation of exposing effect of pulmonary valve through minor thoracic approach

Objective To evaluate the exposing effect of pulmonary valve through minor thoracic approaches. Methods Superior partial median sternotomy, inferior partial median sternotomy, right parasternal approach, left parasternal approach, right anterolaterial minor thoracotomy, left anterolaterial minor thoracotomy, and minor median thoracotomy was imitated on twelve adult cadavers. In these thoracic approaches, the exposing effect of pulmonary valve was observed through the incision on the outflow of right ventricle. Results In superior partial median sternotomy, its inferior end should be made at least to the third intercostal level, otherwise the pulmonary valve would not be exposed well. In inferior partial median sternotomy, its superior end should be made at least to the third intercostal level. The right parasternal approach and the right anterolaterial minor thoracotomy were not suitable for the exposing of pulmonary valve. In minor median thoracotomy, the approaches in the third and forth intercostal level could have satisfactory exposing effect. The left parasternal approach and left anterolaterial minor thoracotomy in the third and forth intercostal level could expose the pulmonary valve well. Conclusion The minor approaches in the right part of thoracic wall could not expose pulmonary valve well. The minor approaches on the median and left part of thoracic wall could expose the pulmonary valve, but it was difficult to establish cardiopulmonary bypass in the approaches on the left part of thoracic wall. Therefore, the partial median sternotomy and the minor median thoracotomy were the suitable approaches for the operation on pulmonary valve.