改良NUSS手术矫治先心病手术后继发性漏斗胸的初步经验  

Preliminary experiences of modified Nuss procedure for acquired pectus excavatum after congenital heart disease surgery

作　　者：吴茂军[1] 宋波[1] 侯龙龙[1] 李瑛[1] 桑桑[1] 李矿[1] 田茂良[1] 吕方启[1] Wu M aojun Song Bo Hou Long-long Li Ying Li Kuang Tian Mao-liang Lv Fang- qi(Affiliated Hospital, Taishan Medical University, Taian 271000, China)

机构地区：[1]泰山医学院附属医院小儿外科,山东省泰安市271000

出　　处：《临床小儿外科杂志》2017年第3期259-261,共3页Journal of Clinical Pediatric Surgery

基　　金：泰安市科学技术发展计划(项目号:20083045)

摘　　要：目的探讨改良Nuss手术矫治先天性心脏病手术后继发性漏斗胸的初步经验。方法2008年6月至2016年1月,我们应用改良Nuss手术治疗3例先心病手术后继发性漏斗胸患者,均为男性;年龄分别为4、4.5和9岁,体重12~21 kg。3例中,2例为室间隔缺损修补术后,1例为法洛氏四联症手术后。畸形为对称性。CT检查Hailer指数5.5±1.5。手术均经剑突下小切口辅助、经原切口完成。结果 3例均成功实施胸骨和心脏分离、Nuss钢板置入手术(均置入l根钢板),矫形效果优良。矫形外观与原发性漏斗胸初次Nuss手术相比效果稍差。术后胸腔引流管放置3 d。2例随访无钢板移位,术后复查CT、心电图正常;1例术后合并皮下气肿,为胸骨后气体顺钢板溢出所致,3 d后自行吸收。2例钢板拆除,钢板分别固定24和28个月,胸廓外形保持良好。结论改良Nuss手术矫治先天性心脏病手术后继发性漏斗胸安全可行,手术中随着局部解剖改变随时调整手术方案是治疗成功的关键。Objective To explore the preliminary experiences of modified Nuss procedure for acquired pectus excavatum after congenital heart disease （CHD） surgery. Methods From June 2008 to January 2016, 3 CHD boys with recurrent peetus exeavatum underwent modified Nuss procedure. The ages were 4,4.5,9 years and weight range was 12 ±21 kg. The causes were ventrieular septal defect （n =2） and tetralogy of Fal- lot （ n = 1 ）. Deformities were symmetric. Hailer＇ s index was 5.5 ± 1.5 on computed tomography （CT）. And a small auxiliary incision was made under xiphoid process. Results The separation of sternum and heart was successful. Nuss steel implant was inserted. All orthopedic outcomes were excellent. Postoperative chest drain- age tube was placed for 3 days. Two cases had no displacement of steel plate. Both CT and electrocardiogram re-examinations were normal. One ease developed postoperative subcutaneous emphysema due to retrosternal gas overflow. Self-absorption occurred within 3 days. Plate fixation screw was removed in 2 cases after fixing for 24 and 28 months. Thoracic cage had an excellent contour. Conclusions Modified Nuss procedure is effica- cious for secondary funnel chest after surgery for CHD.

关 键 词：心脏病/先天性 手术后并发症 漏斗胸 微创性 NUSS手术 

分 类 号：R726.5[医药卫生—儿科]