摘要
目的探讨微创 Nuss 手术治疗漏斗胸对大年龄组病人应用的可行性和手术方法的改良。方法 58例漏斗胸病人在胸腔镜辅助下行改良的 Nuss 手术,其中男45例,女13例;年龄13～32岁,平均(17.03±3.89)岁。按 Haller 指数将损害分为轻、中、重和极重度,中到重度40例,极重度18例。按不同程度来选择 Nuss 手术或两次多点或双弧形支架或双支撑架固定法手术,并评价手术是否安全可行和有效。结果 58例均顺利完成手术,历时35～90min;术中出血3～80ml,平均(7.86±10.44)ml。中到重度者40例采用了 Nuss 手术;极重度的18例中13例采用两次多点固定,2例同时行局部截骨,2例采用双支架,2例采用双弧形支架。术后住院7～12 d,平均(8.64±0.95)d;随访1个月到4年。术中发生支撑架下滑撕开肋间2例,术后支架下滑移位1例,1例间断疼痛2个月,1例持续性疼痛后导致获得性脊柱侧弯,经保守治疗痊愈。结论微创矫正漏斗胸的 Nuss 手术不仅对小儿安全、有效,对青少年,甚至成年人均安全有效,应大力推广。两次多点固定、双支撑架和双弧形支架是修复大龄、严重漏斗胸的可靠方法。
Objective To introduce the procedure, complication and clinical experience with minimally invasivc opertion （Nuss procedure） for peetus excavatum repairing in the elder group. Methods Three hundred and eighteen children suffering from peetus excavatum were corrected by Nuss procedure from July 2002 to December 2006. Tnere were 75 patients were older than 13 years, 58 eases except 17 the reeurzed eases were treated under thoraeoseopie assisted innovaled Nuss surgery （43 were boys and 17 girls）. The mean age was （17.03 ＋ 3.89） years old （ 13-year-old to 32-year-old）. The operation methods were chosen according to Hailer index, which were subdivided into four degrees： slight, middle, severe and extreme severe ones. Resuth 58 patients had cortpletion tff their procedure without intraoperative complications. The operating times ranged from 30 to 90 minutes. All patients were utilized a single steel support bar. The intraoperative blood loss was 3- 80 ml [average （7.86± 10.44） ml]. The 40 eases classifted as middle to severe lesions underwent Nuss operation. For the 18 extreme severe ones, thirteen were adopted natltiple fixation threugh twice procedures, two eases for focal osteotome, two cases deployed dounble brackets, two other eases deployed double arc brackets. The post-operative hospital stay was 7 - 12 days [ （8.64 ±0.95） days ]. The duration of following up was one to to months. In two cases the tore through the intertxals tissues, in one case the brackets glided down, and in one case interrupted pain was present for two months, the other one case with persistent pain, which resulted in secondary scoliosis, and was rotted by conservative treatment. Conclusion The Nuss procedure is a safe and minimally invasive method not only in children but also in teenagers, even adult. Multiple fixations with double brackets and double arc brackets are reliable methods to repair severe pectus excavatum, especially in the elder people.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2007年第3期193-195,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
