5．胸骨正中切開法（再開胸，閉胸も含む）

Median Sternotomy

胸骨正中切開は，あらゆる開心術や上行弓部大動脈に対する手術において良好な術野展開を可能とする．近年，開心術の低侵襲化をめざして肋間小開胸や胸骨部分切開による手術が普及しているが，胸骨正中切開は広い術野を確保できるという点で多くの手術で採用されている．本法は，心臓血管外科専攻医にとって修練の最初に行う手術手技でもあり，閉胸手技も含めて出血やトラブルなく施行できなければならない．

The median sternotomy provides excellent exposure in all open-heart surgeries and procedures involving the ascending aorta. It’s a fundamental technique that cardiac surgeons must learn early in their training and execute safely. During the initial cardiac surgery, thorough detachment of the upper and lower ends of the sternum and precise identification of the sternal midline enable a safe sternotomy. In reoperations, caution is essential due to adhesions on the back of the sternum, requiring careful attention to prevent injury to the heart and major blood vessels. In high-risk cases, readiness to promptly establish cardiopulmonary bypass is crucial. Various types of surgical instruments for sternum closure are commercially available, allowing for appropriate closure depending on the patient’s specific complications and surgical requirements. The use of sternal wires is a standardized method that surgeons should master.