微创漏斗胸修复手术前后患者心肺运动功能的临床观察  

Clinical observation of cardiopulmonary exercise function before and after minimally invasive pectus excavatum repair

作　　者：洪文娟 太祥[1] 洪志鹏[1] 尹小川[1] 余庆鹤[1] 黄韬[1] 孙红文[1] 李海斌[1] 

机构地区：[1]昆明医科大学第一附属医院胸外科,云南昆明650031

出　　处：《中华肺部疾病杂志（电子版）》2012年第3期25-29,共5页Chinese Journal of Lung Diseases(Electronic Edition)

摘　　要：目的探讨漏斗胸修复对心肺运动功能的影响,评价微创漏斗胸修复手术(MIRPE)相对于传统的胸骨抬举、胸骨翻转在漏斗胸(PE)治疗中的优势。方法 196例3～62岁漏斗胸患者于2001年1月至2011年1月行漏斗胸修复手术,患者接受了CT扫描、肺功能、运动耐量以及心功能的检测,微创修复方式包括前期的两切口和后期改进的单切口技术,观察术中出血量、手术时间、术后住院天数和手术满意度。结果术前CT指数5.6±0.8,术后2.51±0.30,统计学差别有显著意义;平均手术出血量、手术时间、术后住院天数和手术满意度MIRPE明显优于传统手术(P<0.01);MIRPE与传统手术后心肺运动功能均有升高,但无统计学差异。结论 CT扫描比胸部X线胸片更直观地显示漏斗胸的严重程度和判断手术治疗效果;手术解除了胸骨对心肺的压迫,术后患者的运动耐量提高,肺功能改善;微创漏斗胸修复手术最大限度的减少了对患者的损伤,技术安全、疗效可靠。Objective To investigate the effect of funnel chest repair on cardiopulmonary exercise function, and the advantages of minimally invasive repair of pectus excavatum （MIRPE） compared with conventional sternum elevation as well as sternum turnover in the therapy of pectum excavatum（PE）. Methods 196 patients were diagnosed as PE in the age of 3 to 62 years, who underwent repair of PE deformities between January 2001 and January 2011. The patients accepted the examinations of chest CT scan, lung function, exercise tolerance testing and heart function. MIRPE included Nuss procedure in the early and the single incision technique modified Nuss procedure in the late. It was observed that the blood loss of operation, operative time, postoperative hospital day, and operative satisfaction survey. The efficacy of treatment of traditional sternum elevation operation, sternum turnover procedure and minimally invasive repair were evaluated. Results CT index was 5.6 ± 0.8 before operation and 2.51 ±0.30 after operation. The difference was considered statistic-ally significant. In MIRPE group, the average blood loss of operation, operative time and postoperative hospital day was superior significantly to the conventional procedure group. The cardiopulmonary effects ameliorate MIRPE compared with sternum elevation and sternum turnover, but the difference was not statistically significant. Conclusions CT scan provides a method of direct view to evaluate the severity of PE and therapeutic effect of the operation compared with chest X ray. The operation removes cardiopulmonary compression of the sternum. The exercise performance of the patients is increased, and pulmonary function is improved. MIRPE decreases the operative injury for the patients to the uttermost. The technique of the procedure is safe and reliable of the therapeutic results.

关 键 词：漏斗胸 NUSS手术 微创 漏斗胸修复 

分 类 号：R655.1[医药卫生—外科学]