不翻转漏斗胸钢板临床应用1020例  

1 020 cases of pectus excavatum treated by a novel modified nuss procedure without turning over the steel plate

作　　者：李国庆[1] 胡丰庆[1] 孟礼飞 胡睿[1] 王明松[1] 肖海波[1] 王磊[1] 梅举[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：《中华胸心血管外科杂志》2018年第1期10-12,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：上海市科委择优委托项目（09DZ1908202）

摘　　要：目的 探讨不翻转漏斗胸钢板矫正漏斗胸的临床效果.方法 2010年6月至2015年7月期间使用新型漏斗胸钢板矫正漏斗胸1020例,其中男706例,女314例;年龄3～40岁,平均（11.38±5.31）岁.Haller指数3.36～15.45,平均4.97±1.58.对称性漏斗胸668例,不对称者281例,复发性71例.患者全麻下平卧,胸腔镜引导下使用不翻转漏斗胸钢板治疗矫正.结果 初次手术时间23～45（32.31±3.57）min,再次手术时间34～147（68.27±30.25）min.术中出血：初次手术者0～2（0.40±0.36）ml,再次1～630（144.00±57.00）ml.术后住院3～9（4.22±0.61）天.随访34～48（34.4±6.1）个月,安装与拆除钢板间隔7～41（23.52±6.17）个月,957例钢板顶在胸骨最低点,58例稍偏离最低点,5例钢板明显移位需再次手术.结论 新型漏斗胸矫正钢板具有简化手术操作、减少手术创伤、减轻患者痛苦的优点,提高了手术效果和安全性. Objective Based on the disadvantages of NUSS procedure, we design a new type of funnel chest orthodontic steel bars for clinical application to simplify surgery operation , reduce the surgical trauma, improve operation effect, enhance the safety of operation, and relieve the suffering of the patients, etc.Methods From June 2010 to July 2015, 1020 patients used the new type of funnel chest orthodontic metal plates, including 706 cases of males and 314 cases of females, aged 3-40（aver-age age 11.38 ±5.31）.Haller index of 3.36 to 15.45（average index 4.97 ±1.58）.668 symmetrical funnel chest cases, 281 cases of asymmetry and 71 recurrent funnel chest cases are involved.Surgical steel bars, having 15 specifications, are arc-shaped, the lengths of which are from 12cm to 26cm.The two ends of steel bars have fixed piece, one end of the bar was fused with a stabilizer and the other end connected to an introducer or a stabilizer and use screws to fix two ends .Steel plates, as the design product, are finalized in the factory.Therefore we need not make intraoperative reprocess.Front tip of introducer and the back-end can be connected to the metal plate.Patients were placed supine position under general anesthesia.Two inci-sions, with length about 2cm and deep to the rib periosteum were made along axillary midline line on the both sides .In the di-rection of high blunt slightly medial free for subcutaneous tunnel to the highest point .Fixed wires were worn around the ribs on both sides.A thoracoscope to guide the bar was inserted from the highest point on the right side of the rear of the medial by sternum low into the chest from the left corresponds to the highest point of the medial , remove the introducer to connect another stator, use screws to fix the connection, with a fixed stator and steel plate stabilized.At the end of the surgery, the stabilizer on either side was secured with sutures.Results The median first operation time was 23 -45（32.31 ±3.57）min, second op-eration time was about 34-147（68

关 键 词：漏斗胸 外科手术 微创性 新型漏斗胸钢板 

分 类 号：R655[医药卫生—外科学]