免翻转钢板矫治成人复发性漏斗胸的临床研究  

A novel modified Nuss procedure without plate turnover for treatment of adult recurrent pectus excavatum

作　　者：谢晓[1] 梅举[1] 李国庆[1] 肖海波[1] 毕锐[1] 蒋连勇[1] XIE Xiao;MEI Ju;LI Guoqing;XIAO Haibo;BI Rui;JIANG Lianyong(Department of Cardiothoracic Surgery,Shanghai Xinhua Hospital,Shanghai Jiao Tong University,School of Medicine,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》2021年第10期1212-1215,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海交通大学医学转化交叉基金(ZH2018QNB28)。

摘　　要：目的总结免翻转钢板治疗成人复发性漏斗胸的经验。方法纳入2010~2019年我院使用胸腔镜辅助下放置免翻转钢板治疗复发性漏斗胸27例患者,其中男23例、女4例,初次手术年龄3~29(12.81±7.79)岁,本次手术年龄18~29(21.74±3.56)岁。手术采用双侧腋中线凹陷水平2~3 cm切口,根据术中情况决定是否加用剑突下辅助切口。结果所有患者均行胸腔镜下免翻转钢板漏斗胸矫治术,11例辅助剑突下小切口完成。25例使用1根钢板,2例使用2根钢板,手术时间28~45(33.00±6.44)min。术后胸部CT扫描提示Haller指数较前明显改善(术前vs.术后:4.63±1.03 vs. 2.95±0.40)。术后住院时间4~6(4.00±0.32)d。术后随访1~8年,并发症包括1例切口愈合不良,1例钢丝断裂移位。随访期间未发现固定片滑脱或钢板移位,14例已经拆除钢板,距离放置钢板时间29~84(40.36±13.93)个月,拆除钢板时Haller指数2.43~3.61(2.86±0.35),截至2020年6月未见漏斗胸复发病例。结论免翻转钢板治疗成人复发漏斗胸疗效满意,肋间肌保护以及牢靠的固定是保证手术成功以及远期效果的关键。Objective To summarize the experience of treating adult recurrent pectus excavatum without plate turnover.Methods Twenty-seven patients with recurrent pectus excavatum treated by thoracoscopy-assisted placement without plate turnover from 2010 to 2019 in our hospital were enrolled.There were 23 males and 4 females with the age of 3-29(12.81±7.79)years at the first operation,and 18-29(21.74±3.56)years at this operation.Incision of 2-3 cm at bilateral axillary midline of the deepest point of pectus excavatum was made,and an auxiliary incision under xiphoid process was adopted according to the intraoperative situation.Results All patients underwent thoracoscopy-assisted correction of pectus excavatum without bar turnover,and subxiphoid incision was performed in 11 patients.Twenty-five patients had one bar placed,and two patients required two bars.The operation time was 28-45(33.00±6.44)min.Postoperative Haller index(2.95±0.40)was improved compared with preoperation(4.63±1.03).The postoperative hospital stay was 4-6(4.00±0.32)day.All patients were followed up for 1-8 years.Complications included poor wound healing in 1 patient,and steel wire fracture and displacement in 1 patient.There was no plate rotation or bar displacement.Fourteen patients removed the bar 29-84(40.36±13.93)months after the placement.Haller index was improved to 2.43-3.61(2.86±0.35)during removal of steel plate.Untill June 2020,there was no recurrence of pectus excavatum.Conclusion The treatment of adult recurrent pectus excavatum without plate turnover is satisfactory,and the protection of intercostal muscle and firm fixation is the key to ensure the success of operation and long-term effects.

关 键 词：复发性漏斗胸 免翻转钢板 成人 手术 

分 类 号：R655[医药卫生—外科学]