胸壁复合组织瓣用于心脏外科小切口的解剖学研究

Anatomic study on horacic complicated pedided tissue flaps used in minimally invasive cardiac approaches

目的 研究以胸壁带蒂复合组织瓣修复心脏手术后胸壁缺损的可行性,并在此基础上设计出新的心脏手术小切口。方法 观察10具尸体前胸壁深层结构的血供规律,测量胸骨外侧缘与胸廓内动脉之间的距离。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。以该动脉为蒂,可以保证多种前胸壁复合组织瓣有良好的血供。结论 用以胸廓内动脉为蒂的前胸壁复合组织瓣修复心脏外科术后胸壁缺损的方法,具有良好的可行性。该方法不但可以克服原有切口的缺陷,而且有助于发现更多心脏外科小切口手术入路。

Objective To study the feasibility of repairing the postoperative chest wall defect in cardiac operations, and devise some new minimally invasive cardiac surgical approaches. Methods The blood supplies of the deeper layers of the chest wall were studied on ten cadavers, the distance between the lateral edge of sternum and internal thoracic artery in every intercostal level were measured. Results The internal horacic artery was the main nutrient artery for the deeper layers of the anterior chest wall. The distance between the sternum and the internal thoracic artery was about 1 cm, which was wide enough for the incision between these two structures without injuring the internal thoracic artery. The internal thoracic artery can be used as a pedicle in various complicated tissue flaps, which could be used to repair the chest wall defect after the thoracotomy in cardiac operations. Conclusion Using complicated pedicled tissue flaps to repair the defect after thoracotomy in cardiac operatons can overcome the disadvantages of some thoracotomy, and can be very helpful to find out some new minimally invasive cardiac approaches.