摘要
目的探讨前胸壁负压盘对提高Nuss手术安全性的作用。方法2004年3月至2014年6月对758例漏斗胸患儿进行Nuss手术，常规Nuss组722例，负压盘辅助组36例。全部患儿经右胸腔镜辅助行标准Nuss手术。负压盘辅助组在穿通器进入右胸腔后，使用国产负压盘置前胸壁开启负压，内凹胸壁即刻上抬，同时顺势将穿通器经前纵隔达对侧胸腔，随后按照常规Nuss术式完成手术。比较两组患儿的年龄、性别、Haller指数、手术时间、术中失血量、术后住院时间、并发症发生率等指标。结果负压盘辅助组31例患儿术前计划选用负压盘，5例术中穿通器过前纵隔困难加用负压盘。其中33例一次负压吸引完成手术，3例需2次以上。36例患儿全部安全完成Nuss手术，无心包和心脏损伤。同常规手术组相比，负压盘辅助组年龄、性别、手术时间、术中失血量、术后住院时间差异无统计学意义（P〉0．05），但Haller指数高于常规手术组（P〈0．05），心包损伤发生率、并发症发生率低于常规组（P〈0．05）。结论Nuss手术实时前胸壁负压盘的应用可通过抬高胸壁扩大术野，有效避免术中血管、心包和心脏的损伤，减少失血量及并发症，简便易行，无创伤，便利手术进程，不失为一种可为Nuss手术提供安全保障的有效方法，值得临床大力推广。
Objective To investigate the efficiency and safety of using vacuum disk on therapy of pectus excavative using Nuss procedure. Methods From Mar 2004 to Jun 2014, 758 children with pectus excavative accepted Nuss surgery, which were divided into two groups： standard Nuss group （722 cases） and modified Nuss group （36 cases）. Both were accepted Nuss procedure using thoracoscope, but the modified group got assistance of vacuum disk when the introducer had been put into fight thorax. The chest wall was elevated as soon as vacuum was on. At the same time, the introducer was pushed into left thorax through anterior mediastinum and then routine procedure was finished. The gender and age ratio, Haller index, operation time, blood loss, postoperative length of hospital stay, complications morbidity were compared between standard and modified group. Results 31 cases of 36 patients in modified group got planned vacuum disk using, 5 cases got unplanned assistance of vacuum disk because it was very difficult to push introducer through anterior midiastinum caused by depressed chest wall. 33 cases finished using once assistance of vacuum disk, and 3 cases twice. All of 36 patients finished Nuss procedure without heart and pericardium injury. There was no difference in gender, age ratio, operation time, blood loss, postoperative length of hospital stay（ P 〉 0. 05 ）, but there was difference in Hailer index and complications morbidity between two gourps （ P 〈 0.05 ）. Conclusion Assistance of vacuum disk during Nuss procedure could extend surgery vision and avoid injury of vessels, heart and pericardium, which was easy to perform and no extra trauma. It was an efficient way to improve the safety of Nuss procedure and deserved to popularize.
出处
《中华胸心血管外科杂志》
CSCD
2015年第9期523-526,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
漏斗胸
NUSS手术
改良
负压盘
Pectus excavative Nuss procedure Modified Vacuum disk
