Nuss手术与传统改良Ravitch术治疗先天性漏斗胸对比分析  

Comparison of Effect of Nuss Procedure and Modified Ravitch Procedure in Treating Pectus Excavatum

作　　者：毛广显 黄贝玉[1] 邓丽娜[2] 程超[1] 马俊[1] 孙磊[1] 钟佛添[1] 巫国勇[1] 

机构地区：[1]中山大学附属第一医院胸外科,广州510080 [2]新乡医学院,河南新乡453003

出　　处：《实用儿科临床杂志》2010年第17期1359-1360,1366,共3页Journal of Applied Clinical Pediatrics

基　　金：广东省科技计划项目(2005B30301021)

摘　　要：目的对比Nuss手术与传统改良Ravitch术治疗先天性漏斗胸（PE）的效果,以提高PE的手术疗效。方法回顾性分析本院2003年1月-2009年8月收治的PE患儿63例。男58例,女5例;年龄3~18岁,中位年龄11.5岁。根据手术方式不同分为Nuss组（24例）和改良Ravitch组（39例）。比较2种术式的手术时间、术中出血量、术后住院时间及术后并发症发生率、矫治效果优良率。结果 63例患儿均顺利完成手术,术后均无心脏大血管、心包损伤等严重致命性并发症。Nuss组手术时间（86.5±7.3）min、术中出血量（25.0±4.1）mL,术后住院天数（6.5±0.3）d,均明显少于Ravitch术[（115.6±6.5）min,（68.2±8.6）mL,（10.0±0.6）d],差异均有统计学意义（Pa〈0.001）。Nuss组术后并发症发生率为16.7%,Ravitch组为43.6%（P〈0.05）。术后随访6个月~2 a,Nuss组优22例,良好1例,优良率为95.8%;Ravitch组优34例,良好4例,优良率为97.4%;二组优良率比较差异无统计学意义（χ2=0.189,P=0.663）。结论 2种术式治疗PE均能达到满意效果,但Ravitch术式并发症较多,而Nuss术微创、切口美观、符合生理、痛苦少,特别适合对称性PE患儿。Objective To compare the effect of Nuss procedure and modified Ravitch procedure in order to improve the curative effect of pectus excavatum（PE）.Methods Totally 63 cases of PE who received repair operation from Jan.2003 to Aug.2009 were followed up.There were 58 male and 5 female,aged from 3 to 18 years old,median 11.5 years old.Among them,24 cases received Nuss procedure and 39 cases received modified Ravitch procedure.The operation time,blood loss,duration of postoperative hospitalization,postoperative complications,excellent and good rate of correct outcomes were compared between 2 groups.Results Operations were successfully performed in all cases.There were no severe complications in both groups.The operation time,blood loss,and duration of postoperative hospitalization were shorter in Nuss group[（86.5±7.3） min,（25.0±4.1） mL,（6.5±0.3） d] than those in the modified Ravitch group[（115.6±6.5） min,（68.2±8.6） mL,（10.0±0.6） d]（Pa0.001）.The rate of postoperation complications in Nuss group was less than in Ravitch group（16.7% vs 43.6%,P0.05）.These patients were followed-up 6 months to 2 years after operation,in Nuss group,22 cases were excellent,1 case was good,the excellent and good rate was 95.8%;In Ravitch group,34 cases were excellent,4 cases was good,the excellent and good rate was 97.4%.No significant difference was found in excellent and good rate of cosmetic outcomes（χ2=0.189,P=0.663）.Conclusions Both Nuss procedure and modified Ravitch procedure can result in excellent and good cosmetic outcomes for PE.But Nuss procedure is easy to perform with less invasion,less pain,more suitable to physical condition.Therefore,Nuss procedure is a better choice for PE,especially for symmetric cases.

关 键 词：漏斗胸 NUSS手术 改良RAVITCH手术 儿童 

分 类 号：R726.5[医药卫生—儿科]