微创漏斗胸矫形术术后并发症危险因素分析  

Analysis of risk factors for complications after Nuss procedure for pectus excavatum

作　　者：余平文 张晨雷[1] 刘宏旭[1] Yu Pingwen;Zhang Chenlei;Liu Hongxu(Department of Thoracic Surgery,Liaoning Provincial Cancer Hospital ＆ Institute,Shenyang 110042,China)

机构地区：[1]中国医科大学肿瘤医院、辽宁省肿瘤医院胸外科,沈阳110042

出　　处：《中华小儿外科杂志》2018年第9期654-659,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的 分析微创漏斗胸矫形术（Nuss手术）的矫形效果、术后并发症发生危险因素及其处理.方法 回顾性分析2009年9月至2016年4月在中国医科大学肿瘤医院胸外科行Nuss手术75例患者的临床资料.其中,男68例,女7例;未成年患者59例,成年患者16例;术中置入1块钢板者66例,2块钢板者9例.结果 75例患者均顺利完成手术.其中30例患者于出院后中位随访36个月（33～46个月）后成功取出钢板,且经过中位随访23个月（1～43个月）,29例患者胸廓畸形得到满意矫正.另45例患者经中位22个月（5～40个月）随访,44例患者胸廓畸形得到满意矫正,满意度高.术中无一例出现危险并发症,无死亡病例.术后出现近期并发症16例（21％）,近期并发症包括气胸（10例）、切口愈合不良（4例）、胸腔积液（1例）和臂丛神经一过性麻痹（2例）,经积极处理后,均恢复顺利;远期并发症主要为钢板移位（2例）,再次行Nuss手术后,畸形满意纠正.单因素和Logistic回归多因素分析发现,漏斗胸对称与否（OR=7.045,P=0.011）、年龄（OR=7.416,P=0.011）和置入钢板数（OR=15.180,P=0.005）是Nuss手术后并发症发生的独立危险因素.结论 Nuss手术治疗漏斗胸安全、有效,近/远期均为可接受的轻度并发症,一旦出现应积极处理.年龄≥18岁、非对称型患者,通常需2块钢板行内固定,是Nuss术后并发症发生的独立危险因素.Objective To analyze the Nuss procedure results,risk factors responsible for postoperative complications and management of postoperative complications.Methods We restrospectively reviewed the clinical data of pectus excavatum （PE ） patients undergoing Nuss procedure from September 2009 to April 2016.There were 68 boys and 7 girls,59 children patients and 16 adult patients,66 patients with one bar and 9 patients with two bars implanted.Results Seventy-five patients were recruited and all operations were completed successfully.In 30 patients,bars were removed successfully during a median follow-up period of 36 （33-46）months.In 29 patients,chest wall deformities were corrected during a median follow-up period of 23 （1-43）months.In 44/45 patients, chest wall deformities were corrected during a median follow-up period of 22 （5-40）months.There was no severe intraoperative complications.No death occurred perioperatively.Postoperative recent complications occurred in 16 patients （21 ％）.Early complications of pneumothorax （n = 10）,incision malunion （n = 4 ）,pleural effusion （n = 1 ）and temporary brachial plexus paralysis （n = 2 ）were managed successfully.Two cases of late complications underwent redo Nuss procedure with satisfactory outcomes.Both univariate and multivariate analyses showed that PE symmetric or not （OR=7.045,P =0.011）,age （OR=7.416,P =0.011）and numbers of bars implanted （OR=15.180, P = 0.005 ） were independent risk factors for postoperative complications after Nuss procedure. Conclusions Nuss procedure is both safe and effective for correcting pectus excavatum.Early and late postoperative complications are mild and acceptable and may be handled actively and successfully.Age 18 years and above,asymmetric PE and internal fixation requiring 2 bars are independent risk factors for postoperative complications after Nuss procedure.

关 键 词：漏斗胸 漏斗胸矫正术 并发症 危险因素 

分 类 号：R655[医药卫生—外科学]