Nuss术治疗小儿漏斗胸的CT指数评估  

Evaluation of Nuss procedure in children using computed tomographic index

作　　者：洪春巧[1] 李炘[1] 陶麒麟[1] 郑一鸣[1] 贾兵[1] 陈张根[1] 

机构地区：[1]复旦大学附属儿科医院心胸外科,上海201102

出　　处：《中华小儿外科杂志》2010年第1期8-11,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨采用CT指数客观评估Nuss手术治疗小儿漏斗胸效果的价值。方法2005年5月至2009年1月，采用胸腔镜辅助下改良Nuss术治疗115例中重度漏斗胸患儿，将已拔除钢板的30例患儿作为研究对象。采用胸部CT扫描分别测量术前、Nuss术后、拔除钢板后的CT指数，进行对比研究。选取年龄匹配的30例排除胸部畸形的患儿作为对照组。将实验组分为小年龄组（≤10岁）22例及大年龄组（〉10岁）8例；对称型组18例及不对称型组12例；中度组（CT指数≤5）18例及重度组（CT指数〉5）12例。各组之间进行对比及统计分析。结果实验组Nuss术后以及拔除钢板后的CT指数与术前进行配对t检验显示差异均具有统计学意义（P〈0．001），拔除钢板后CT指数与Nuss术后相比，差异无统计学意义（P=0．472），并且与对照组的2．48±0．24相比，差异无统计学意义（P=0．057）。小年龄组与大年龄组Nuss术后及拔钢板后的CT指数与术前相比，差异均有统计学意义（P〈0．05），而两组之间相比，差异均无统计学意义（P=0．093，P=0．116）。对称型组和不对称型组Nuss术后及拔钢板后的CT指数与术前相比，差异均有统计学意义（P〈0．05），而两组之间相比，差异均无统计学意义（P=0．281，P=0．610）。中度组和重度组Nuss术后及拔钢板后CT指数与术前相比，差异均有统计学意义（P〈（）．05），两组之间Nuss术后相比，差异有统计学意义（P〈O．05），但拔钢板后差异无统计学意义（P=0．093）。结论CT指数可以客观地评估Nuss术矫治小儿漏斗胸术后乃至拔除钢板后的手术效果。无论年龄、畸形类型及畸形程度，Nuss手术均能取得良好效果。Objective To evaluated the results of the Nuss procedure children using computed tomographic index. Methods We performed the Nuss procedure in 115 patients between May 2005 and January 2009. Thirty of these patients have the chest bars removal. Computed tomographic scans were obtained before.after the Nuss procedure and after the bar removal. The three CT indices were then calculated. Computed tomographic scans of 30 age-matched patients without chest deformity were col- lected as controls. Patients were divided into the younger （〈 or = 10 years of age, n = 22） and older （〉10 years of age, n = 8） groups, symmetric groups （n = 18） and asymmetric group （n = 12）, and groups with mild （n = 18） and severe （n = 12） deformity using a pre-CTi value of 5 as demarcation. These CT indices were compared and statistically analyzed. Results The mean preoperative CTi in all cases was 5.35 ± 3. 03. CTi improved to 2. 86 ± 0. 42 after Nuss procedure, stabilized at 2. 82 ± 0. 42 after bar removal. The postoperative and post-bar-removal CTi was significantly less than the preoper- ative CTi （P〈0. 001）, but not significantly different from each other （P = 0. 472）. The post-bar-re- moval CTi was not significantly different from that of the control （2. 48 ± 0. 242, P = 0. I）57）. Compu- ted tomographie index of the young group improved from 5.55 ± 3. 47 to 2. 78 ± 0. 42 then to 2. 75 ± 0. 41, and the older group from 4. 81 ± 0. 98 to 3. I）8 ± 0. 33 then to 3.03 ± 0. 39. The post-operative and post-bar-removal CTi values were not significantly different between the younger and the older groups （P = 0. 093, P = 0. 116）. CT index of the symmetric group improved from 4. 92 ± 1. 1 2 to 2. 79 ± 0. 43 then to 2. 79 ± 0. 46, and the asymmetric group from 6. 00 ± 4. 51 to 2. 97 ± 11. 43 then to 2. 87 ± 0. 36. These post-operative and after-bar-removal CTi values were not significantly different respec- tively （P = 0. 281, P = 0. 610）. In the group with mild depression, the pr

关 键 词：漏斗胸 胸外科手术 体层摄影术 X线计算机 

分 类 号：R816[医药卫生—放射医学] R726[医药卫生—临床医学]