中断肋骨和腋下中断肋骨剖胸新方法及1980例报道  

A NEW METHOD OF MEDIAN-RIB-SECTION IN POSTERAL AND SUBAXILLARY THORACOTOMY AND REPORT OF 1980 CASES

作　　者：仇德惠[1] 王群[1] 谭黎杰[1] 徐正浪[1] 曾亮[1] 郑如恒[1] 石美鑫[1] 

机构地区：[1]上海医科大学中山医院胸外科

出　　处：《上海医科大学学报》1998年第4期310-313,共4页Journal of Fudan University(Medical Science)

摘　　要：目的设计剖胸切口保留肋骨的新方法———中断肋骨剖胸方法。使剖胸切口手术创伤更小，术野显露更满意；设计腋下中断肋骨剖胸切口，增大腋下剖胸径路术野暴露范围，以扩大该切口径路直视手术的应用范围。方法中断肋骨进胸方法是在剖胸切口选定的拟切断肋骨的中央部位切断该肋骨后分别剥离切断肋骨的前、后半段肋骨下缘及上缘部分的肋骨骨膜。然后向上、下两个方向撑开切断的前后半段肋骨，经肋床进胸，此即前上型中断肋骨进胸方法；反之则构成后上型中断肋骨进胸方法。腋下中断肋骨剖胸切口是在腋下作１４～１８ｃｍ的弧行皮肤切口，不切断胸背肌群，不切除肋骨，采用上述中断肋骨的方法进胸。结果我们在１９７３例经后外侧切口施行手术的病例中几乎１００％采用了中断肋骨剖胸切口。又开展腋下中断肋骨剖胸切口施行各类手术１８０例。经后外侧中断肋骨剖胸切口的术野暴露面积与切除肋骨的后外侧切口相似而大于其他保留肋骨的方法且手术创伤小；腋下中断肋骨剖胸切口的暴露面积明显扩大，从而能在直视下满意地完成一大部分常见的普胸外科手术。结论通过千余例的临床应用表明中断肋骨进胸的方法手术操作简单，出血少，术后病人肋骨对位好，无胸壁凹陷畸形，肩关节活动度及上肢肌力恢复佳，术后病人生活?おURPOSE To designe a new method of median-rib-section in posterolateral and axillary thoracotomy incision by keeping the lying rib. The former new design makes less traumatic and more clear exposure in posterolateral thoracotomy and the later makes axillary thoracotomy more useful in thoracic surgery. METHODS We used the method of median-rib-section to enter the thorax through the rib bed instead of the traditional methods which remove the lying rib or keep the rib by transecting it either at the anterior of at the posterior part of the rib. We prefered two types of the entry path. One was called anterosuperior type. Superiorly the rib periosteum was cleaned with elevator from behind in a forward direction to the median position of the rib, and inferiorly, the periostieum was cleaned from front in a bac

关 键 词：胸外科手术 肋骨 腋下剖胸切口 切口 中断肋骨 

分 类 号：R655[医药卫生—外科学]