胸骨下部Y形小切口心内直视手术的解剖学基础与临床应用

Anatomical study and clinical application of the Y shaped ministernotomy approach in intracardiac operation under direct vision

目的：探讨胸骨下部Ｙ 形小切口心内直视手术的解剖学基础及临床应用。方法：采用胸骨下半部正中劈开，至胸骨角下方２ ｃｍ 处向左上、右上方剪开胸骨，使切口成Ｙ 形，行体外循环心内直视手术２７ 例，观测皮肤切口、胸骨纵切口、显露主动脉、肺动脉、右心及左心范围。结果：患者全部恢复良好，无手术死亡及严重并发症。全组皮肤切口，胸骨纵切口，显露主动脉，显露肺动脉平均长度分别为８ ．８ ±１ ．８ ｃｍ ，８ ．１ ±２ ．２ ｃｍ 、２ ．５ ±０ ．８ ｃｍ 、１ ．５ ±０ ．６ ｃｍ 。全组平均体外循环时间、主动脉阻断时间、手术时间分别为８５ ±４５ ．４ ｍｉｎ 、３９ ．４ ±３０ ．６ ｍｉｎ 、１８０ ．５ ±５１ ．１ ｍｉｎ 。术后平均呼吸机辅助呼吸６ ．１ ±５ ．６ｈ 、术后第１ 天平均出血量１５０ ±７１ｍｌ，平均输血量１５０ ±１４３ｍｌ，术后住院时间９ ．７ ±１ ．５ 天，术后患者无胸骨畸形，切口疤痕小。结论：胸骨下部Ｙ 形小切口心内直视手术显露好，创伤小，出血少，术后恢复快，具有安全性及较好的美容效果。

To investigate the feasibility of “Y” shaped mini sternotomy approach at lower sternum was applied in intracardiac operation in the view of anatomy and clinic.Methods:A “Y” shaped mini sternotomy at lower sternum was applied on 27 patients with intracardiac operation.The length of skin incision,sternum incision and exposure of aortic artery,pulmonary artery and heart were observed.Results:This new ministernotomy approach produced a very satisafctory result on all patients without operative mortality and severe operative complications.The lengths of skin incision,strnum incision,of exposed aortic artery and pulmonary artery(from the )averaged out ot 8.8±1.8 cm,8.1±2.2 cm,2.5± 0.8 cm and 1.5±0.6 cm respectiviely.The mean time of extracorporeal circulation,aortic cross clamp and total operation was 85±45.4,39.4±30.6 and 180.5±51.5 minutes separately.The mean postoperative artificial ventilation time was 6.1±5.6 hours.The volume of bleeding in the first postoperative day was 150±71mL and the volume of blood transfusion was 150±143ml.There were no sternoschisis and less scared in the sternotomy after operation.Conclusion:This “Y” shaped mini sternotomy approach in intracardiac operation possessed the advantages of good exposure,less invasion,safety and cosmetic effect.