摘要
目的 总结单切口改良Nuss手术矫治儿童漏斗胸的手术方法、临床经验及早期效果。方法2013年5月～2014年12月，选择性采用单切口改良Nuss手术治疗65例儿童漏斗胸，平均年龄5．3岁（4～12岁）。根据Park分型，对称型41例，不对称型24例。术前胸部CT测量Haller指数3．21—12．54（4．654-1．56）。手术采用新型钛合金支架，支架前端为圆钝收窄的穿通段，具有穿通胸骨后及肋间隙的功能。手术仅做一处右侧胸壁2em横行小切口，置人支架及胸腔镜，已塑型的支架凸面朝下由右侧肋弓最高点经胸骨最低点至左侧肋弓最高点穿出，支架翻转后前端置于左侧胸壁皮下，皮下保留2～3em。右侧切口内放入固定片，以螺丝与支架固定。根据术后Hailer指数及随访结果评价手术效果。结果全组手术顺利，采用胸腔镜辅助手术63例。手术时间19～45min，平均26min。全组均植入1根矫形支架。术后并发气胸1例、胸腔积液1例、切口感染1例。术后3个月胸部CT测量Haller指数2．21～3．12（2．48±0．36），术后6个月2．18～3．24（2．45±0．32），与术前相比均有显著差异（t=6．286、6．487，P=0．000、0．000）。所有患儿随访9～28个月，矫形效果满意，无支架移位、获得性脊柱侧弯、金属过敏等并发症，未出现支架前端横向移位脱入胸腔。结论在低龄以及稍大龄轻症漏斗胸患儿中使用新型单孔钛合金支架施行单切口改良Nuss手术，安全可行，矫形效果满意，而且切口更美观，操作更简化，手术更微创。
Objective To summarize the clinical experience and evaluate the early outcomes of modified single-incision Nuss procedure for pectus excavatum in children. Methods A total of 65 children with pectus excavatum who were chosen to undergo modified single-incision Nuss procedure from May 2013 to December 2014 were reviewed retrospectively. Patients＇ age ranged from 4 to 12 years old （mean, 5.3 years old）. According to the Park classification, there were 41 cases of symmetric type and 24 cases of asymmetric type. The mean preoperative Hailer index measured by CT scanning was 4.65 ＋ 1.56, ranged from 3.21 to 12.54. A new type of titanium peetus bar was used in the operation. The front end of the bar was tapered into a round and blunt point which was designed to be an introducer into the substernal and intercostal space. A single 2-cm transverse incision was made on the right chest wall and no incision was required on the left chest＇wall. The titanium bar and thoracoscope were put through the same incision. The bar was inserted with the convexity facing down, passing from the highest point of right rib bow via the lowest point of the sternum to the highest point of left rib bow, and then it was turned over to raise the sternum to normal position. The front end of the bar was put under the skin of the left chest wall, with 2 - 3 cm length of the end retained subcutaneously. The stabilizer was connected on the right end of the bar to support the bar and keep it in place. Postoperative operational outcomes were evaluated with Hailer index and follow-up results. Results The operations were performed successfully in all the patients. The procedure was performed with the assistance of thoracoscope in 63 cases. The operation time ranged from 19 to 45 min （ mean, 26 min）. Only one bar was implanted in all the patients. Early postoperative complications included 1 case of pneumothorax, 1 case of pleural effusion and 1 case of wound infection. The Haller index was 2.48 ±0.36 （range, 2.21 -3. 12） at 3-month postoperatively and 2.45 ±0.32 （range, 2. 18-3.24） at 6- month postoperatively, all of which were significantly less than the preoperative level （ t = 6. 286 and 6. 487, P = 0. 000 and 0. 000 ）. All the patients were fi）llowed up for 9 -28 months, during which none of them had recurrence or late postoperative complications, such as bar dislocation, acquired scoliosis, of metal allergy. And no occurrence of the left end of the bar dislocated into the chest happened. Conclusions Use of new type titanium pectus bar in the modified single-incision Nuss procedure for younger children and mild eases is safe and convenient, with no impairment to the growth and development of children＇ s chest wall. This procedure has less injury, more satisfactory cosmetic results and fewer complications.
出处
《中国微创外科杂志》
CSCD
北大核心
2016年第2期127-130,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
漏斗胸
NUSS手术
微创手术
单切口
Pectus excavatum
Nuss procedure
Mininally invasive surgery
Single-incision
