新改良NUSS手术临床应用初步体会  

A report on an improved NUSS procedure and its clinical application

作　　者：李国庆[1] 梅举[1] 丁芳宝[1] 肖海波[1] 胡丰庆[1] 王明松[1] 谢晓[1] 陈寅[1] 王磊[1] 

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,200092

出　　处：《中华小儿外科杂志》2013年第7期493-496,共4页Chinese Journal of Pediatric Surgery

基　　金：上海市科委择优委托项目资助（09DZ1908202）

摘　　要：目的在NUSS手术的基础上进一步简化手术操作、改善治疗效果并降低术后并发症。方法回顾性分析我院2010年2月至2011年1月收治的漏斗胸患儿103例，其中男93例，女10例，年龄3～14岁，大面积扁平胸加漏斗胸10例，不对称性漏斗胸11例，包括伴部分鸡胸样隆起不对称性漏斗胸3例，复发性漏斗胸5例，其余为基本对称性漏斗胸。矫形钢板采用由我院自主研发的新型改良漏斗胸矫治钢板，按钢板的厚度及宽度不同又分为大小二种型号，钢板的一端与固定片融合，另一端可与引导头或固定片套接。垫片有多种型号可供选择以适应不同类型漏斗胸类型。患儿平卧位，于双侧腋前线各作一长1．5～2．5cm的切口，深至肋骨骨膜外，沿肋骨骨膜外间隙向胸骨方向分离至胸廓最高点，该点与胸骨最低点在同一水平线上。于腋中线第8肋间打孔置人胸腔镜作引导。用带引导器的钢板的引导头从右面间隙进入，从最高点肋间进右胸，从胸骨最低点后方穿过纵隔，从左侧最高点肋间穿出胸壁（这2个最高点也与胸骨最低点在同一水平线上），并沿左侧间隙及左切口引出引导器，作胸壁塑形，卸去超微创漏斗胸矫治钢板上的引导头，套接上固定片，螺丝固定后，双侧固定片与胸壁肌肉各固定1针，缝合肌肉、皮下及皮肤。结果103例均获良好矫形效果，8例大面积扁平胸加漏斗胸按NUSS手术常需用2根钢板，我们仅用了1根新改良型钢板也获得了较好的矫形效果。所有患儿术后均可侧卧位。结论新改良钢板具有不需术中加工、安装及拆卸安全方便、不影响患儿胸壁的生长发育等优点；新改良NUSS手术操作简便，效果良好，患儿术后并发症少，疼痛轻、可侧卧。Objective To present the improved NUSS procedure for children with funnel chest. Methods From February 2010 to January 2011, 103 patients （93 males and 10 females）with funnel chest （Pectus Excavatum） underwent surgery in this institution. They aged from 3 to 14 years. There were 10 cases with large area of flat chest plus funnel chest, 11 cases with asymmetrical funnel chest which including 3 cases with partial pectus carinatum like asymmetrical uplift, and 5 cases with recurrent funnel chest. With the help of computer-aided design, we invented the steel bars that had independent intellectual property rights. The steel bars were divided into two types according to their thickness and width. One end of the bar vSas fused with a stabilizer and the other end connected to an introducer or a stabilizer. There were many different pads choices to match the different types of funnel chest. Patients were placed supine position. Two incisions, with length about 1.5-2. 5 cm and deep to the rib periosteum were made along anterior axillary lines on the both sides. Along the outer space of the periosteum, the separation toward the highest point of thoracic chest was made, the highest point and the lowest point of sternum were on the same line. A thoracoscope to guide the bar was inserted through a small incision at the middle axillary line and the 8th intercostal space. The steel bar with an introducer on the head was pushed from the right incision along posterior to the sternum and ribs, anterior to the heart and lungs, and through the highest point of left thoracic chest, ending at the left incision. Then the introducer was removed, and the bar was flipped. The metal plates （stabilizers） were connected on the left end of the bar to support the bar and kept it in place. The stabilizer on either side was secured with sutures. Results Good orthopedic effect was achieved in all patients. One steel bar per patient was used for 8 cases with large area flat chest plus funnel chest, while the NUSS procedure required two

关 键 词：漏斗胸 胸外科手术 外科手术 微创性 

分 类 号：R726[医药卫生—儿科]