J.Jpn. Surg. Soc.. 90(5): 786-792, 1989

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Original article

MEDIAN STERNOTOMY FOR LUNG AND TRACHEAL SURGERY

Median sternotomy was used in 30 cases of lung surgery ; (1) lung cancer with impaired pulmoanry function or local invasion to the mediastinum-12 cases. An average FEV_1.0, 960ml, 38% FVC was only reduced to 890ml one month after lobectomy. (2) concomitant heart disease-2 cases. A 5 year old boy, with tracheal stricture and tetralogy of Fallot, was successfully treated by one stage operation. Stenotic cartilage trachea, 2mm in diameter, was resected 15mm in length and anastomosed end to end under total extracorperaeal circulation after cardiac operation. A left .up per lobectomy for lung cancer was performed under partial extracorporeal circulation after mitral valve replacement and valvoplasty of tricuspid valve on a 62 year old man. Both patients are well two years after operation. (3) bilateral pulmoanry lesions-11 cases. (4) others-5 cases.
Median sternotomy provides less operative loss of lung function, and excellent exposure for selected cases. But these advantages may be lost in some cases in No. (3), when fragile metastatic nodules must be gently manipulated and when an autosuture must be used in different direction for bullae. Whether or not the median sternotomy or posterolateral skin incision is favorable, may be decided by CT findings preoperatively.

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