漏斗胸外科治疗:30年406例经验回顾  

Surgical treatment of pectus excavatu m: 30-years experience in 406 patients

作　　者：胡廷泽[1] 

机构地区：[1]四川大学华西医院小儿外科,成都610041

出　　处：《中华小儿外科杂志》2005年第8期393-396,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的复习漏斗胸外科治疗30年经验并讨论相关应用研究结果.方法406例2～18岁漏斗胸于1975～2005年3月在四川大学华西医院小儿外科接受手术治疗(包括23例外出手术).后期病例接受了CT、心肺功能检查,以及在相关的应用研究中,对手术操作不断完善.早期8例施行胸骨翻转术(sternoturnover),其余病例均施行胸骨上举术(sternal elevation).上举术主要包括从肋软骨膜下切除畸形的肋软骨,胸骨前的横向楔形切骨术,金属板横向穿过矫形后的胸骨体予以固定.要获得好的矫形效果,在手术操作中及术后要求做到下列5点:①保护肋软骨与肋骨连接部(costochondraljunction);②将切开的软骨膜缝合修复呈'管套'状;③不切断与胸骨缘相连的肋间束;④将金属板向前弯曲为适度的'弓'形;⑤术后体疗,如维持挺胸姿势和与扩胸有关的锻炼,金属支架(metal strut)固定1年.结果312例获1～16年随访.3例复发,其中2例需再次手术.少数病例前胸壁外形不够理想,但胸骨后面与椎体前面之间距离增大,使心脏位置及心功能恢复,达到同龄健康儿童水平,而大多数患儿同时获得了正常的胸廓外观.术后肺功能的恢复则较缓慢.结论认真做到改良手术操作中要求的5点,是获得远期手术良好效果的关键.最适当的手术时机是3～7岁.改良胸骨上举术可获得良好的胸廓塑形与心肺功能的迅速恢复,并发症低,远期疗效好.Objective To review the surgical repair of pectus excavatum chest deformities in our institution over the previous 30-year period. Methods 406 patients who underwent repair of pectus excavatum deformities between 1975 and March 2005 were reviewed. The diagnoses were based on history,physical examination, X-ray, CT, cardiopulmonary function examination. With the exception of 8 “sterno-turnover” operation early in the series, all patients underwent sternal elevation. Repair was achieved with sub-periosteal resection of the abnormal cartilages, transverse wedge osteotomy of the anterior sternum, and internal support with a metal strut for one year. The sternal elevation procedure consists of： ① preservation of the costochondral junctiom ②formation of “pipe” shaped perichondriurn;③preservation of the intercostal muscle ④formation of the metal strut “arch” and ⑤encouraging chest expansion exercise post-operatively. The patients were followed up for 1 to 16 years. Results The costal cage was enlarged in all but in three patients. Exercise tolerance was improved, and cardiac function was restored to that of normal children, while pulmonary function recovered very slowly after surgery. Conclusions The normal appearance of chest wall and normal cardiopulmonary function can be restored by the modified sternal elevation procedure with a low complication rate and excellent longterm physiological and cosmetic results.

关 键 词：漏斗胸 外科手术 治疗 心肺功能 胸骨翻转术 胸廓塑形 

分 类 号：R655[医药卫生—外科学]