食管超声监测下非胸腔镜辅助Nuss手术85例分析  

Non-thoracoscopic Nuss procedure for correcting pectus excavatum with trans-esophageal echocardiography monitoring

作　　者：徐冰[1] 牟玲 李文华 刘文英[1] 

机构地区：[1]四川省医学科学院&四川省人民医院小儿外科,成都610072 [2]麻醉科 [3]超声科

出　　处：《中华小儿外科杂志》2016年第5期361-365,共5页Chinese Journal of Pediatric Surgery

基　　金：广东省科技厅科技计划项目课题（2014A020212026）;广州市科技局应用基础研究专项课题（2013J4100021）

摘　　要：目的探讨食管超声监测下非胸腔镜辅助Nuss手术的手术方法和治疗经验。方法2011年8月至2014年8月本院对适合的漏斗胸病例采用食管超声监测下非胸腔镜辅助Nuss手术矫治漏斗胸，共85例患儿，其中男61例，女24例。年龄7岁8个月至17岁5个月，平均13岁2个月。胸廓指数（Hallerindex）在3．6～14．2之间，平均4．1。79例为初次漏斗胸手术，6例为复发漏斗胸，64例患儿置入1根钢板，21例置入2根钢板。结果85例患儿均顺利完成手术，无术中严重并发症发生。手术时间28-70min，平均40min出血量10-40ml，平均15ml。全部患儿术后未出现伤121感染，恢复顺利，术后5～7d出院，平均6d。本组22例患儿术后钢板安置满3年已手术移除钢板。85例均获随访，随访时间14-38个月，平均23个月。患儿疼痛消失，活动量增加，无不适表现，患儿和家属满意矫形效果。结论使用食管超声监测，术中能够比较清楚的反映术中心脏大血管及心包的状态，可以有效的发现并避免术中严重的并发症，食管超声在漏斗胸手术中为一种有效的监测手段。Objective To review our experiences of correcting pectus excavatum through Nuss procedure with non-thoracoscopic assistance trans-esophageal echocardiography monitoring. Methods A total of 85 patients of pectus excavatum underwent Nuss procedure with non-thoracoscopic assistance trans-esophageal eehocardiography monitoring. There were 61 boys and 24 girls with an average age of 158 （92-209） months, including first pectus excavatum operation （n = 79） and postoperative recurrence after traditional pectus excavatum correction （n = 6）. The mean Haller index was 4. 1 （3.6-14. 2）. And the number of bar was 1 （n = 64） and 2 （n = 21）. Results All operations were successful without any severe complication. The mean operative duration was 40 （28-70） min, mean hemorrhagic volume 15 （10-40） ml and mean time from operation to discharge 6 （5-7） days. And the bars were removed in 22 patients within 3 years. Excellent thoracic wall was maintained during an average follow-up period of 23 （14-38） months. Conclusions Nuss procedure of nonthoracoscopic assistance trans-esophageal echocardiography monitoring is both effective and miniinvasive for correcting pectus excavatum.

关 键 词：漏斗胸 NUSS手术 食管超声监测 

分 类 号：R726.5[医药卫生—儿科]