经第1肋间隙胸腔穿刺引流的解剖学基础及应用

Anatomical base and clinical application of thoracic drainage and thoracentesis through first intercostal space

目的 总结经第1肋间隙胸腔穿刺引流的解剖学基础及临床应用。方法 26具成年人尸体标本,测量锁骨中线与第1肋上缘交点(引流点)至胸顶诸条血管的最近距离,对10例经第1肋间隙胸腔穿刺引流的患者进行临床观察。结果 引流点至锁骨下静脉的距离左侧为(29.6±1.9)mm,右侧(28.0±1.5)mm;至锁骨下动脉左侧(32.2±1.6)mm,右侧(31.6±1.8)mm;至无名静脉左侧(34.0±1.6)mm,右侧(33.8±1.5)mm;至胸廓内动脉左侧(30.0±2.1)mm,右侧(29.8±2.0)mm。临床观察表明,此引流点对胸膜腔顶部的包裹性残腔疗效满意。结论 临床上采用第1肋间隙胸腔穿刺引流是可行的,当病变高于第2肋间时,可采用经第1肋间隙穿刺引流胸腔。

Objective To report the anatomical base and clinical application of thoracic drainage and thoracenlesis through first intercostal space. Methods The distances between the drainage point in the first intercostal space (middle point of the clavicle and at the upper border of the first rib)and the adjacent blood vessels were measured in 26 adult human cadavers. 10 cases using first intercostal drainage were analyzed retrospectively. Results The distances of the drainage point to the adjacent blood vessels on the left and right side were (29.6 ±1.9) mm and (28.0 ± 1. 5)mm respectively for subclavian vein; (32.2 ± 1.6)mm and (31.6 ± 1.8)mm for subclavian artery; and (34.0 ± 1 .6)mm and (33.8 ± 1.5)mm for innominate vein; (30.0 ± 2.1 )mm and (29.8 ± 2.0)mm for internal mammary artery. 10 cases treated with first intercostal drainage revealed good recovery without any adverse effects. Conclusion The anatomical findings and clinical practice confirm the applicability of first intercostal drainage in some specific pathological conditions at the apex of the the thoracic cavity. However, the author emphasize that the second intercostal space should be chosen for routine upper thoracic drainage so far as safety is concerned.