漏斗胸的手术设计与新型改良Nuss手术  

Surgical design and novel modified Nuss procedure for pectus excavatum

作　　者：王磊[1] 胡丰庆[1] 王明松[1] 肖海波[1] 李国庆[1] 梅举[1] WANG Lei;HU Fengqing;WANG Mingsong;XIAO Haibo;LI Guoqing;MEI Ju(Department of Cardiothoracic Surgery,Xinhua Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200092,P.R.China)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海200092

出　　处：《中国胸心血管外科临床杂志》2020年第8期900-906,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海市转化医学协同创新中心项目(TM201709)。

摘　　要：目的探索新型改良Nuss手术矫治漏斗胸的效果并总结漏斗胸手术设计经验。方法回顾性分析2013年1月至2017年4月在我院行新型改良Nuss手术治疗的漏斗胸患者903例的临床资料。其中男716例、女187例,年龄2~45(12.1±6.8)岁。术前Haller指数(Haller index,HI)3.1~15.2(4.6±1.3),其中轻度漏斗胸(HI<3.2)38例,中度漏斗胸(HI 3.2~3.5)302例,重度漏斗胸(HI 3.6~6.0)521例,极重度漏斗胸(HI>6.0)42例。观察患者手术时间、术中出血量、术后住院时间及相关并发症。结果所有患者均顺利完成手术。特殊漏斗胸组(复发漏斗胸、心脏术后漏斗胸及2根钢板植入漏斗胸)手术时间为48~150(63.5±28.1)min,术中出血量为15~50(23.5±5.5)m L。普通漏斗胸组手术时间为20~45(25.2±2.6)min,术中出血量少于10 mL。术后3~15(4.5±1.6)d出院。845例(93.6%)患者植入1根钢板,58例(6.4%)患者植入2根钢板。术后疗效评估优805例,良84例,中14例,差0例,优良率达98.4%。结论优化手术设计,简化手术流程,新型改良Nuss手术治疗漏斗胸安全有效。Objective To explore the surgical design and efficacy of novel modified Nuss procedure for pectus excavatum(PE).Methods We retrospectively analyzed the clinical data of 903 patients with PE who were treated by the new kind of steel bar and the novel modified Nuss procedure.There were 716 males and 187 females at mean age of 2-45(12.1±6.8)years.Preoperative chest CT scans Haller index(HI)was 3.1-15.2(4.6±1.3),with 38 patients of mild PE(HI<3.2),302 patients of moderate PE(HI 3.2-3.5),521 patients of severe PE(HI 3.6-6.0),and 42 patients of extremely severe PE(HI>6.0).The operative time,operative blood loss,hospital stay time as well as postoperative complications were reviewed and analyzed.Results All of the 903 patients successfully completed the surgery.The mean operative time was 20-45(25.2±2.6)min for primary PE and that for special type of PE(including recurring PE,PE patients after heart disease operation and those corrected by 2 bars)was 48-150(63.5±28.1)min.Blood loss was less than 10 mL for primary PE and 15-50(23.5±5.5)mL for special type of PE.Postoperative hospital stay was 3-15(4.5±1.6)d.A total of 845 patients(93.6%)required 1 steel bar insertion,58 patients(6.4%)required 2 steel bars.Postoperative evaluation of the surgery outcomes revealed the following:excellent in 805 patients,good in 84 patients,fair in 14 patients and poor in 0.The good quality rate was 98.4%.Conclusion Novel modified Nuss procedure can simplify and optimize the surgical design with good short and mid-term effects.

关 键 词：手术设计 新型改良Nuss手术 漏斗胸 治疗 

分 类 号：R655[医药卫生—外科学]