经腋中线直切口行Nuss手术纠治小儿漏斗胸  

Longitudinal Incision in Midaxillary Line in Nuss Procedure for Repairing Congenital Pectus Excavatum in Children

作　　者：闫宪刚[1] 沈晟[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：《中国微创外科杂志》2013年第6期546-548,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的总结经腋中线直切口行Nuss手术纠治小儿漏斗胸的手术技巧和疗效。方法 2010年6月～2012年1月,对18例先天性漏斗胸采用两侧腋中线直切口进行胸腔镜辅助下Nuss手术,手术年龄5岁2个月～11岁8个月,平均7岁3个月。根据Park分型,对称性11例,不对称性7例。Haller指数3.3～10.8,4.68±1.73。结果 18例均顺利完成手术,手术时间30～55 min,(42.2±6.5)min。术中失血量<10 ml。1例发生少量气胸,保守治疗气胸消失。伤口均愈合良好。住院时间(5.1±1.0)d。术后3个月门诊随访,手术效果:优14例,良4例。18例随访时间3～18个月,(10.0±4.5)月,其中5例>12个月,支架钢板无明显移位或滑脱,胸廓外形发育良好。胸廓矫正满意,正面和侧面手臂下垂时均无法发现腋中线切口。结论经腋中线直切口行Nuss手术纠治小儿漏斗胸是可行的,特别对于女性患者,可以避免影响乳腺的发育和外观。Objective To summarize the effect and technique of longitudinal incision at midaxillary line in Nuss procedure for children with congenital pectus excavatum. Methods Nuss procedure were performed using the longitudinal incision at midaxillary line in 18 patients with congenital pectus excavatum from June 2010 to January 2012 in our hospital. The age of the patients ranged from 5 years and 2 months to 11 years and 8 months with an average of 7 years and 3 months. I1 patients were symmetric pectus excavatum and 7 patients were asymmetric pectus excavatum according to Park＇ s classification. The Hailer index ranged from 3.3 to 10.8 with a mean of （4.68 ± 1.73 ）. Results All operations were successful. The operation time was 30 - 55 min with a mean of （42.2 ± 6.5） min, and the blood loss was less than 10 ml. One patient suffered from pneumothorax in early postoperative period and recovered after conservative treatment. The hospital stay was （5. 1 ± 1.0） d. Three months of out-patient follow-up showed that 14 patients （77.8%） had excellent recovery and 4 patients （22.2%） had good results 3 months after the surgery. All patients were followed up for 3 to 18 months with a mean of （ 10.0 ± 4.5 ） months （5 cases for more than 12 months）. All steel support bars were in the original position without displacement. All patients had satisfactory deformity correction results with normal chest shape. The longitudinal incision was unable to be detected in the front and lateral side when arm was drooping. Conclusions The longitudinal incision at midaxillary line in Nuss procedure is a safe and reliable modified technique to be used clinically, especially suitable for female patients to avoid the impairment of their mammogenesis.

关 键 词：NUSS手术 漏斗胸 腋中线直切口 

分 类 号：R726.8[医药卫生—儿科]