与先天性心脏病相关的NUSS术  

Corrective surgery for congenital heart disease combined with NUSS procedure for pectus excavatmn as one staged operation

作　　者：石卓[1] 徐玮泽[1] 李建华[1] 陈自力[1] 俞建根[1] 梁靓[1] 张泽伟[1] 舒强[1] 

机构地区：[1]浙江大学医学院附属儿童医院心胸外科,浙江省医学重点学科小儿心胸外科,杭州310003

出　　处：《中华小儿外科杂志》2011年第4期278-281,共4页Chinese Journal of Pediatric Surgery

基　　金：浙江省科技厅项目资助（编号：2004C30011）

摘　　要：目的探讨同期治疗合并先天性心脏病（先心）的漏斗胸及先心术后漏斗胸应用NUSS术的方法及可行性。方法统计我院2006年7月至2010年6月与先心相关的漏斗胸15例，A组8例合并先心的漏斗胸患儿在同期行心脏手术和NUSS术，其中男5例，女3例，年龄4岁～13岁4个月（平均6岁1个月）。其中4例行室间隔缺损经胸伞封术，2例行房间隔缺损经胸伞封术，1例在体外循环下行室间隔缺损修补术，1例在体外循环下行右室双腔矫治及室间隔缺损修补术。B组7例均为先心术后的漏斗胸行NUSS术，其中男5例，女2例，先心手术年龄6个月～3岁1（）个月（平均1岁9个月），NUSS术年龄4岁7个月～8岁（平均6岁2个月），6例为体外循环下室间隔缺损修补术后，1例为体外循环下法乐四联症矫治术后。术后常规放置有心包纵隔和／或胸腔引流管。结果所有患儿手术顺利，A组术后5～14h拔除气管插管，平均（8．8±2．6）h。B组术后4～8h拔除气管插管，平均（5．9±1．2）h，48-72h拔除心包纵隔或胸腔引流管。无手术死亡、大出血及胸腔脏器损伤等并发症。术后检查先心矫治效果良好，肺复张良好。术后两组各出现1例切口延期愈合，经治疗后，均顺利出院。随访6个月～4年效果良好。结论NUSS术用于治疗先心术后漏斗胸以及同期治疗合并先心的漏斗胸安全可行，可有效降低或避免二次手术的难度及风险。Objective To investigate the clinical outcomes of combining corrective surgery for congenital heart disease （CHD） and NUSS surgery for pectus excavatum （PE） as one-staged operation. Methods From July 2006 to June 2010, 15 children with CHD associated with PE were recruited in this study, and divided into two groups： group A underwent one-staged and group B with twostaged operation. Group A had 8 patients including 5 males and 3 females, aging from 4 to 13. 4 years （mean, 6 years and 1 month）. Among the 8 patients, 6 with ventricular septal defect （VSD） and 2 with atrial septal defect （ASD） underwent interventional or open repair. After the corrective surgery for their CHD, the 8 patients underwent NUSS procedure for pectus excavaturru The group B had 7 patients, including 5 males and 2 females. Among them, 6 had VSD and 1 had tetralogy of fallot （TOF）. At the first stage, the patients underwent corrective surgery to repair VSD and TOF under CPB. At the second stage, the patients were performed NUSS surgery to correct PE. Their ages at surgery were 4 years and 7 months to 8 years old （mean, 6 years and 2 months）. Results All operations were finished successfully. The endotracheal tube was removed 5 to 14 hours after surgery on Group A patients （mean, 8. 75 ± 2. 59 h）, and 4 to 8 hours on Group B patients （mean, 5.86 ± 1. 24 h）. The drainage tubes of pericardium, mediastinal or chest were removed 48 to 72 h later after surgery. The patients were followed up for 6 months to 4 years. No surgery-related death, hemor- rhage, thoracic organ dysfunction and other severe complications were noted. Delayed wound healing was observed on 1 patient in each group. Others recovered from surgery and were discharged from the hospital. Conclusions It is safe to combine corrective surgery for CHD and NUSS procedure for PE as one stage operation.

关 键 词：漏斗胸 心脏病 先天性 体外循环 

分 类 号：R726.5[医药卫生—儿科]