METHOD FOR SURGICAL APPROACH TO THORACIC AORTA

摘要

FIELD: medicine.;SUBSTANCE: invention refers to medicine, namely cardiosurgery, and can find application in surgeries of prosthetic repair of aneurisms of the entire thoracic aorta. Substance of the method consists in intercostal thoracotomy and transverse incision of sternum. The sternal edges are at 1.0 cm at the level of I intercostal space. Investing tissues, pectoral fascia and presternum are incised by counter incisions inclined at 20-30 degrees to a horizontal line. The investing tissues are incised along a left border of mesosternum. Ends of II-V ribs are separated therefrom, and anterior mediastinum is exposed. Pleural fold is incised and pleural cavity is exposed. In V intercostal space, internal thoracic vessels are ligated and transected, intercostal thoracotomy is performed to left posterior axillary line. Intercostal wound edges are opened with a dilator. Sternal rib ends separated from sternum together with attached greater pectoral muscle bundles are dislocated towards I rib and brought entoectad by another dilator. A lower fragment of the incised sternum is brought inwards. From the pleural cavity, left diaphragm nerve is separated from pericardium. A diaphragm portion of pericardium is separated from diaphragm to a right-side seam. Lung and heart apex are antepositioned. That is followed by exposure of all portions of thoracic aorta so that to create vascular anastomoses. Closure of the incisional wound is preceded by drainage of anterior mediastinum, pericardium cavity, and left pleural cavity. The wound along the sternum is closed by edges of periosteum, pectoral fascia and tendon elements of sternocostal joint capsules. Sternum is repaired by through interrupted sutures.;EFFECT: use of the given invention allows minimising a sternal injury at the stage of the surgical approach to thoracic aorta and a probability of developing sternal osteomyelitis and anterior purulent mediastinitis in the remote postoperative period, improving parameters of the incisional wound.;1 dwg