胸腔镜辅助下Nuss手术微创矫治漏斗胸的疗效观察  

Nuss PROCEDURE BY THORACOSCOPY FOR MINIMALLY INVASIVE CORRECTION OF PECTUS EXCAVATUM

作　　者：李斌[1] 张建华[1] 苟云久[1] 王志强[1] 王成[1] 宋铁牛[1] 杨建宝[1] 

机构地区：[1]兰州大学第二医院胸外科,兰州730030

出　　处：《中国修复重建外科杂志》2013年第5期599-602,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结胸腔镜辅助下Nuss手术微创矫治漏斗胸的临床疗效。方法 2009年9月-2012年1月,于胸腔镜辅助下行Nuss手术微创矫治33例漏斗胸。男26例,女7例;年龄3～22岁,中位年龄9岁。其中1例为Ravitch术后3年复发,余均为初次手术。24例有明显临床症状。Haller指数为3.3～50.1,平均5.6。漏斗胸根据简化Park分型标准:对称型25例,偏心型5例,不均衡型3例。结果术中发生1例肋间肌撕裂,术后发生1例胸腔积液、1例肺部感染、1例持续胸背疼痛。手术时间38～89 min,平均60.9 min;术中出血量8～90 mL,平均26.2 mL。住院时间6～12 d,平均7.6 d。患者均获随访,随访时间12～39个月,平均25.6个月。心电图和胸部X线片示心脏压迫改善,临床症状缓解。随访期间无支撑钢板移位。末次随访时,根据Nuss等的标准评估手术效果,获优27例、良3例、中3例,优良率达90.9%;年龄<6岁、6～12岁及>12岁患者间疗效比较,差异均无统计学意义(Z=—1.751,P=0.109)。结论胸腔镜辅助下Nuss手术矫治漏斗胸具有创伤小、手术操作简便、术后恢复快等优点,矫形效果满意,根据患者情况弯制个体化支撑钢板是获得满意矫治效果的保证。Objective To summarize the effectiveness of Nuss procedure by thoracoscopy for correction of pectus excavatum. Methods Between September 2009 and January 2012, 33 patients suffering from pectus excavatum underwent Nuss procedure by thoracoscopy. There were 26 males and 7 females, aged from 3 to 22 years （median, 9 years）. There was primary operation in 32 cases and reoperation in 1 case after Ravitch procedure. Twenty-four patients had obvious clinical symptoms. The Hailer index ranged from 3.3 to 50.1 （mean, 5.6）. According to simplified Park classification, 25 cases were classified as symmetric type, 5 as eccentric type, and3 as unbalanced type. Results Intercostal muscle tear occurred in 1 case during operation; pleural effusion, pulmonary infection, and thoracic vertebral pain occurred in 1 case, respectively after operation. The operation time ranged from 38 to 89 minutes （mean, 60.9 minutes）. The intraoperative blood loss was 8-90 mL （mean, 26.2 mL）. The postoperative hospitalization days were 6-12 days （mean, 7.6 days）. All patients were followed up 12- 39 months （mean, 25.6 months）. Electrocardiogram and chest X-ray film showed that cardiac compression was improved, and symptoms alleviated. At the last follow-up, according to the Nuss standard, the results were excellent in 27 cases, good in 3 cases, and fair in 3 cases, with an excellent and good rate of 90.9%. There was no significant difference in results of effectiveness evaluation among less than 6 years, 6-12 years, and more than 12 years groups （Z= -1.751, P=0.109）. Conclusion Nuss procedure by thoracoscopy has the advantages of little trauma, simple operation, and fast recovery, so it can obtain satisfactory correction ofpectus excavatum.

关 键 词：漏斗胸 NUSS手术 胸腔镜 

分 类 号：R655[医药卫生—外科学]