改良胸骨翻转术治疗小儿先天性漏斗胸20年经验  

Modified sternal turnover operation f or pectus excavatum in chidren: 20 years experience in single institution

作　　者：李炘[1] 陈张根[1] 贾兵[1] 王人荣[1] 张善通[1] 

机构地区：[1]复旦大学附属儿科医院胸心外科,上海200032

出　　处：《中华小儿外科杂志》2005年第8期401-403,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的总结近20年采用改良胸骨翻转术治疗先天性漏斗胸120例的经验.方法1985～2004年,手术治疗先天性漏斗胸120例,男98例,女22例,年龄2～15岁,体重10～28 kg.有反复呼吸道感染史48例,活动耐量减低45例.心电图有不完全性右束支传导阻滞38例,心室肥厚26例,窦性心律失常31例,T波改变或心肌劳损55例.X线胸片均显示有不同程度的心脏左移.肺功能检查有限制型通气障碍24例.漏斗胸指数(FI)大于0.3有43例,FI在0.2～0.3之间有71例,FI小于0.2有6例.结果全组病例术后均见明显效果.早年1例发生胸骨缺血坏死.肺不张和/或肺部感染6例,胸腔积液3例,伤口感染2例,均痊愈出院.术后住院7～40 d(平均10 d).随访1～15年,胸骨呈正常平坦,无一复发.结论改良胸骨翻转术治疗先天性漏斗胸近远期效果满意.Objective To review the twenty-year-experience of pectus excavatum in children undergoing a modified sternal turnover operation. Methods One hundred and twenty consecutive patients with pectus excavatum underwent a modified sterno-turnover operation between 1985 and 2004 in this institution. There were 98 male and 22 female. Mean age at operation was 4. 6 years （range 2-15）. The age in 93% patients was from 3 to 6 years. Mean body weight was 13.1 kg （range 10-28）.Forty-eight patients （40%） had recurrent upper respiratory tract infection, while 45 （37. 5%） had a decrease in exercise tolerance. The scoliosis was found in 5 patients （4. 2%）. ECG changes were quite common including incomplete right bundle branch block in 38 patients （31.7%）, ventricular hypertrophy in 26 （21.7%）, sinus arrhythmia in 31 （25. 8） and T wave changes or cardiac damage in 55 patients （45. 8%）. The heart was deviated into the left thoracic cavity to varying degrees in all the patients demonstrated by chest radiographs. Twenty four of 35 patients （68. 6%） had dysfunction of restrictive ventilation by lung function examination. The index more than 0. 3 was found in 43 patients（35.8%）, 0. 2 to 0. 3 in 71, and less than 0. 2 in 6. Results All the patients had marked postoperative improvement in thoracic configuration. No patient was observed to have paradoxical breathing postoperatively. One patient （0. 83%） suffered from sternal necrosis. Other early postoperative complications included atelectasis and/or pneumonia in 6 patients （5 %）, hydrothorax in 3 （2. 5%） and wound infection in 2 （1.7%）. All the patients recovered uneventfully. The mean postoperative hospital stay was 10 days （range 7-40）. The postoperative follow-up was available in most patients ranging from 1 to 15 years. No recurrence was occurred. The patients had normal shape or mild flat of the chest. The heart returned to its normal site. The patients had an increase in exercise tolerance.Conclusions Pectus excavatum

关 键 词：改良胸骨翻转术 治疗 儿童 先天性漏斗胸 

分 类 号：R726.5[医药卫生—儿科]