5．胸骨正中切開（再開胸・閉胸も含む）

Median Sternotomy （Re-do and Closure）

胸骨正中切開は，心臓血管外科における基本手技である．低侵襲心臓手術（MICS）が発展し，さまざまな心臓手術手技がMICSで完遂可能になってきているが，すべての手技が実行できるわけではない．MICSと比べて胸骨正中切開は感染制御，美容などの面で劣る点があるが，広く良好な視野が得られ，手術操作の煩雑さは回避でき，いまだもっとも広く使われる切開法である．胸骨正中切開手技を，術後合併症のなきように確実かつ丁寧に実行することが肝要である．

Median sternotomy is a basic procedure in the cardiovascular surgery. Minimally invasive surgery （MICS） develops and becomes able to accomplish various operation on the cardiovascular surgery, but it cannot carry out all maneuvers. Medline incision is inferior at beauty and infection control than MICS. But medianstenotomy is still used widely. It’s provided good field of vision and the incision method that evade the complexity of the operation. It is vital to carry it out surely and carefully so that there are not later complications by mediansternotomy. It is necessary to be careful about the right ventricle injury the case of the redo-sternotomy.