经第1肋间穿刺引流胸腔的解剖学可行性及临床意义

The Anatomical Feasibility and Clinical Significance of Thoracic Drainage and Thoracentesis through First Intercostal Space

对局限于第２肋间以上的胸顶部需引流病变，尤其是感染性疾病的治疗，需要探讨更局部位的治疗点。作者在２０具成年人尸体上观察到，锁骨中线上第１肋间至胸顶部诸条血管仍有一定的安全距离，临床选用该点引流胸腔病变存在解剖学可行性，尤其对胸顶部的包裹性残腔疗效满意。但从安全性考虑，仍应强调第２肋间为高位胸腔引流的常规位置；仅在常规位置达不到引流目的时，尤其是病变高于第２肋间，可考虑选用第１肋间为高位胸腔引流部位。

The second or third intercostal space is usually chosen for thoracentesis or thoracic drainage for spontaneous orpostoperative pneumothorax riather than the first intercostal space, mainly to avoid injury of the neighboring blood vessels.However, the first intercostal space maybe preferable for managing some high lying pathological conditions .In order to studythe feasibility and safety of approach through the first intercostal space, 20 adult human cadavers were studied anatomically.The results demonstrated that the distances between the drainage point in the first intercostal space ( middle point of the clavi-cle and at the upper border of the second rib )and the adjacent blood vessels on the left and right side were 32.0±1.5mm and38.0±2.0mm respectively for subclavian artery; 30.0±2.0mm and 28.0±1.5mm for the subclavian vein; 35.0±1.5mmand 29.0±2.0mm for innominate vein; 28.0±8mm and 26.0±7mm for internal mammary artery. Retrospective analysesof 10 cases treated with first intercostal drainage revealed good recovery without any adverse effects. The pathological condi-tions or lesions included residual apical dead space in 4 cases, encapsulated apical pyopneumothorax in 3, spontaneous pneu-mothorax with localized adhesions at the second and third intercostal space in 2 and encapsulated apical empyema in 1. Theclinical practice and anatomical findings confirm the applicability of first intercostal drainage in some specific pathological con-ditions at the apes of the thoracic cavity. However, the authors emphasize the second intercostal space should be chosen forroutine upper thoracic drainage so far as safety is conerned.