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1.
目的总结改良胸骨抬举术治疗儿童先天性漏斗胸268例的经验。方法2002年1月至2005年12月收治儿童漏斗胸268例中男213例,女55例;年龄2~16岁,平均(4.48±2.74)岁,其中2-3岁印例,3—6岁130例,6岁以上印例。均行改良胸骨抬举术,即胸壁横形小切口、断或不断胸骨、少切肋软骨、肋骨断端用丝线缝合、自行设计的钢板胸骨前悬吊固定。伴肺囊肿、大叶性肺气肿病儿同时行肺叶切除术;伴食管裂孔疝病儿同时行食管裂孔疝修补术;伴先心病病儿同时行先心病根治术。结果全组无死亡。术后除1例合并肺炎、2例皮下少量积液外,余恢复良好。所有病儿术后随访1~5年,除1例胸骨下段轻度凹陷外,余均有良好外观的胸廓。术后已取出钢板165例,均能维持原有胸廓形态。结论改良胸骨抬举术具有切口小、损伤轻、并发症少、疗效佳、固定牢靠、材料低廉,适用于任何类型的漏斗胸病儿,不失为目前治疗儿童漏斗胸的一种良好的手段。  相似文献   

2.
漏斗胸修复术的胸廓重塑   总被引:13,自引:2,他引:11  
为了探索漏斗胸修复术后如何才能重塑一个完善的胸廓,对1975年10月~1996年12月,采用的胸骨翻转术8例,胸骨上举术143例治疗的漏斗胸患儿,进行了3个月~14年随访。结果表明,术后3个月即可发现重建的胸廓有新生肋软骨再生,6个月时变得较坚韧,1年时已成为基本正常的胸廓,此时拔除金属支杠最佳。认为,肋软骨的再生是胸廓重塑的基础,应按照肋软骨再生规律,改进手术操作。术后坚持康复疗法,均可获得一个较满意的胸廓  相似文献   

3.
改良胸骨上举术治疗漏斗胸   总被引:1,自引:0,他引:1  
目的探讨改良胸骨上举术治疗漏斗胸以取得操作简便、创伤小、不易复发的手术方法。方法通过松解剑突后牵拉纤维束、矫正胸肋软骨反向关节畸形、胸骨前板V形截骨钢丝固定、斜形切除部分软骨牵拉固定等改进胸骨上举术方法治疗漏斗胸。结果1997年3月以来,治疗8例漏斗胸患儿,其中4例术前心率快者术中解除胸骨压迫后心率立即减缓。术中出血少,术后胸部形态恢复正常,活动能力明显改善。未出现气胸、感染等并发症。随访6个月~1年,未见畸形复发。结论改良胸骨上举术治疗漏斗胸畸形是安全有效的治疗方法。  相似文献   

4.
目的 总结带上下血管蒂的改良胸骨翻转术治疗漏斗胸22例的经验.方法 1998年2月至2008年5月手术治疗漏斗胸22例,均为男性,年龄4~20岁,漏斗胸指数均大于0.2.全组均采用保留双侧胸廓内动脉和带腹壁上动脉的腹直肌蒂的胸骨180°翻转方式,翻转后两侧胸廓内动脉及两侧带腹壁上动脉的腹直肌均呈十字交叉状置于胸骨前.结果 全组病例术后胸骨凹陷均得到完全纠正,胸廓外形满意,术后无一例发生胸骨缺血坏死,切口均Ⅰ期愈合.术中胸膜破裂16例(73%),术后并发症主要为胸腔积液2例(9.1% ),均痊愈出院.术后住院10~15d(平均12d),随访3个月~4年,未见复发.结论 带上下血管蒂的改良胸骨翻转术治疗漏斗胸近远期效果满意.  相似文献   

5.
胸骨抬举加肋软骨成形治疗小儿漏斗胸   总被引:3,自引:0,他引:3  
目的 总结胸骨抬举加肋软骨成形治疗小儿漏斗胸的经验。方法 1994年1月至2003年10月,采用胸骨楔形切骨后缝合固定和肋软骨部分切除成形后缝合固定的方法治疗57例漏斗胸小儿,随访6个月~10年,内容包括胸廓外形、临床症状、胸部X线正侧位片。结果 无手术死亡,除1例术后6个月胸骨出现轻度下陷外,其余矫形效果满意,临床症状明显好转,术后漏斗指数FI与正常儿童差异无显著性。结论 胸骨抬举加肋软骨成形治疗小儿漏斗胸近、远期效果满意。  相似文献   

6.
目的探讨儿童漏斗胸微创手术矫治后胸廓骨的重塑及临床疗效。方法回顾性分析2009年4月至2010年9月北京军区总医院74例漏斗胸患者经微创手术矫治的临床资料,其中男63例,女11例;年龄(11.90±8.50)岁,10岁11例。74例患者于全身麻醉下在两侧腋中线做切口,在电视胸腔镜下引导穿通器经胸骨后创出通道,并抬举胸骨成形后,再将制备好的支撑板置入胸骨后。术前和术后1周行胸部CT、胸廓CT三维重建,矢状位以胸椎体中心线为切线位,测量胸骨与胸椎体前缘的距离,并观察心脏移位恢复情况和胸廓外形。结果 74例均顺利完成手术,无手术死亡。使用1根矫形板66例(89.19%),使用2根矫形板8例(10.81%)。使用1根矫形板、年龄10岁的11例患者术后7 d胸骨柄下端和胸骨体各部位与术前比较均向前移位3.76~22.92 mm,11~17岁的55例使用1根矫形板患者胸骨体中间和下端与术前比较分别向前移位2.08 mm和10.42 mm,两者胸骨体下端较术前向前移位的距离比较差异有统计学意义(t=14.24,P0.05)。术后7 d时11~17岁使用2根矫形板患者胸骨柄下端和胸骨体各部位与术前比较向前移位4.19~15.03 mm。术后7 d胸部CT显示65例(87.84%)患者心脏位置恢复正常;用2根矫形板患者胸廓外观优于用1根者。随访74例,随访率100%;随访时间6~23个月,患者术前临床症状消失,胸廓外形饱满,心脏位置完全恢复正常。结论儿童漏斗胸微创手术矫治一次性成形具有良好的重塑性;随着年龄增加,矫治支撑胸骨的力也需要增加,且疗效满意。  相似文献   

7.
胸壁、胸膜     
20060616胸骨旁“门式切口”的应用解剖学研究,20060617肋-软骨连结损伤对胸廓发育影响的实验研究,20060618漏斗胸外科治疗:30年406例经验回顾,20060619Nuss手术与改良Ravitch手术的对比研究,20060620改良胸骨翻转术治疗小儿先天性漏斗胸20年经验。[编者按]  相似文献   

8.
采用腹直肌蒂胸骨瓣翻转成形术治疗漏斗胸8例。手术要点在于充分游离腹直肌,切断肋软骨时尽量保留软骨膜的完整,慎勿损伤腹直肌的肋软骨附着部及腹壁上动脉。8例术后胸骨凹陷完全矫正,胸廓外形恢复正常。经半年以上随访,患儿活动量明显增加,X 线复查胸骨与肋骨断端已完全愈合。  相似文献   

9.
采用腹直肌蒂胸骨瓣翻转成形术治疗漏斗胸8例。手术要点在于充分游离腹直肌,切断肋软骨时尽量保留软骨膜的完整,慎勿损伤腹直肌的肋软骨附着部及腹壁上动脉。8例术后胸骨凹陷完全矫正,胸廓外形恢复正常。经半年以上随访,患儿活动量明显增加,X线复查胸骨与肋骨断端已完全愈合。  相似文献   

10.
腹直肌蒂胸骨瓣翻转成形术   总被引:2,自引:0,他引:2  
采用腹直肌蒂胸骨瓣翻转成形术治疗漏斗胸8例。手术要点在于充分游主腹直肌,断肋软骨时尽量保留软骨膜的完整,慎铁损伤腹直肌的肋软骨附着部及腹壁上动脉。8例术后胸骨凹隐完全短正,胸廓外形恢复正常,经半年以上随访,患儿活动量明显增加,X线复查胸骨与肋骨断端已完全愈合。  相似文献   

11.

Purpose

The aim of the study is to review the surgical experiences with pectus excavatum (PE) chest deformities at the Department of Pediatric Surgery, West China Hospital of Sichuan University (Sichuan, PR China), during a 30-year period.

Method

Records of 398 PE patients (396 congenital, 2 acquired) who underwent surgical repair between 1975 and 2005 were reviewed. Modified sternal elevation was applied in all patients. Repair was performed with subperiosteal resection of the abnormal cartilages, transverse wedge osteotomy of the anterior sternum, and internal support with a metal strut for 1 year. Five technical details were strictly followed for each case. Three hundred twelve patients (78.39%) were followed up from 1 to 16 years.

Result

There were no deaths. Normal contour of the costal cage was constructed postoperatively in 98.74% (393/398) of the patients. Exercise tolerance was improved, and cardiac function recovered to the healthy level of same age. But pulmonary function recovered slowly after surgery.

Conclusions

The 5 technical details are key principles for sternal elevation. Normal appearance of chest wall can be recovered; normal cardiopulmonary function can be restored by the modified sternal elevation with excellent long-term physiologic, cosmetic results and low rate of complications.  相似文献   

12.
Re-operation of pectus excavatum   总被引:1,自引:0,他引:1  
We performed surgical reconstruction on 1655 cases of deformed thoracic cage, we later operated again on 11 of these to repair postoperatively re-deformed anterior chest walls. Based on these experiences, we have concluded as follows. 1: Postoperative recurrence of funnel chest deforming is mainly due to insufficient resection of costal cartilages. In particular transection of the sternum at low levels during sternal turn-over procedure results in postoperative recurrence of depression in the upper anterior chest wall. 2: In young children who have undergone sternal turn-over procedure, the first and second costal bones and cartilages overgrow and protrude anteriorly, and in compensation their junctions to the sternum recess posteriorly. This results in a depression in the upper anterior chest wall. 3: We recommend sternal turn-over with overlapping of the sternum for repair of postoperative funnel chest deformity. Through this procedure, the extent of resection of costal cartilages can easily be determined and the depression of the anterior chest wall satisfactorily reconstructed. 4: In re-do surgery, we obtained pathological evidence confirming our clinical experience that our sternal turn-over technique does not interfere with blood circulation or development of the turned-over sternum even though the sternum is not connected to the rectus abdominus muscle pedicle, preserved internal mammary vessels, or anastomosis of the internal mammary vessels.  相似文献   

13.
BACKGROUND: It is generally accepted that pectus excavatum should be repaired in childhood if possible. The procedure could be performed conveniently even without implantation of any foreign material. In contrast there are several adult patients with aesthenic or marfanoid habitus and poor thorax cosmetics, who seek medical help especially surgical correction due to late awareness or cardiopulmonary dysfunction. METHODS: Between 1989 and 1997, 22 adult patients (mean age 26 years, 18 males and 4 females) underwent repair of the pectus excavatum in our institution. Patients data were analysed retrospectively. Indication was mainly for aesthetics or cardiopulmonary symptoms, in 3 patients for recurrence after primary repair elsewhere. The total surgical repair technique consisted of V-shape osteotomy of the ribs at the outer and inner limit of the funnel and transverse osteotomy of the sternum without displacement of the posterior cortical The sternal and chest wall stabilization in corrected position was performed with at least two metal struts installed transsternal and transversely. In most of our cases other diagonal struts on both sides were needed to achieve further stabilization of the lowest costal cartilages. The metal struts are removed 1 year after the procedure. RESULTS: All repairs were completed with a low complication rate. Chest radiographs and pulmonary function studies were performed routinely before and after corrective surgery. Good to satisfactory chest contour was achieved in 20 patients (91%), with a follow-up from 5 months to 8 years. CONCLUSIONS: Our current technique with perioperative management is successfully performed in adults and will be presented.  相似文献   

14.
We report a 12-year-old girl with Sprintzen-Goldberg syndrome (SGS) who was complicated with annuloaortic ectasia with aortic regurgitation, mitral valve prolapse with mitral regurgitation, and a severe pectus excavatum. In this patient, aortic root replacement, mitral valve replacement, and sternal elevation were simultaneously performed, and a version of Ravitch's procedure that was technically modified to support the sternum was used for sternal elevation. This modified sternal elevation technique gave excellent operative exposure, and maintained chest wall stability after the operation.  相似文献   

15.
Background  Severe pectus excavatum (PE) is common, often causing physiologic impairment. Inconsistent results have been reported using a variety of open surgical techniques with extensive subperiosteal costal cartilage resection. Methods  Since 1969, 912 (80% men) symptomatic PE patients (mean severity index 4.9) underwent open surgical correction at UCLA Medical Center by one surgeon. Almost all patients had dyspnea, reduced endurance, tachypnea, and tachycardia with exertion. The mean age at operation was 19.8 years. Asymmetric depression was present in 465 (51%) patients; combined PE and pectus carinatum was present in 33 patients. Recurrent PE deformities were repaired on 73 patients. Progressively less deformed costal cartilage was resected during the 38-year period; almost all of the last 303 patients had only short segments excised from both ends with suture reattachment. Transverse wedge sternal osteotomy was used on all patients, and 883 (97%) had a sternal support strut for 6 to 9 months. Results  Dyspnea, endurance, tachypnea, and tachycardia was improved in almost all patients within 5 months after repair. Repair for recurrent deformities and resection of mild localized cartilage protrusion was reduced more than threefold when minimal cartilage resection with wire reattachment was used. Postoperative complications in the last 537 patients were less frequent, pain was less severe, and results were better than when more extensive previous repairs were used (mean follow-up 7.6 years). Very good or excellent results were reported by 94.2% of all patients. Conclusions  In this largest series of open PE repair, progressively less extensive operative techniques have resulted in low morbidity, mild pain, short hospitalization, and very good physiologic and cosmetic results.  相似文献   

16.
目的 介绍一种改良REV手术治疗合并室间隔缺损(VSD)、肺动脉瓣狭窄(PS)的复杂型大动脉转位或右心室双出口(DORV)。方法 2005年9月~2006年2月我院收治3例复杂型先天性心脏病患者,在经典REV手术的基础上,我们改良了REV手术,保留了肺动脉瓣和瓣环进行手术治疗。结果 2例痊愈,1例同时用体外膜式氧合器(ECMO)进行抢救后死亡。痊愈患者分别随访4个月和1个月,超声心动图检查提示肺动脉瓣跨瓣压差分别为15mmHg和5mmHg,结果满意。结论 保留肺动脉瓣的改良REV手术对治疗合并VSD、PS的复杂大动脉转位是一种较为理想的手术方法。  相似文献   

17.
Background Breast and chest wall disfiguration attributable to a funnel chest is an aesthetically and sometimes functionally debilitating deformity requiring surgical correction. Whereas extensive and combined deformities of the ventral chest wall are classically corrected using a so-called minimally invasive repair of the pectus excavatum, a modified Ravitch repair, or the minimized Erlangen repair, plastic surgeons are mostly challenged with alloplastic implant corrections of mild funnel chests. The authors have introduced an endoscopic method for placement of customized implants to restore the visible and nonfunctionally disturbing deformation of mild funnel chests when only the sternal plate is involved. This study compared these different plastic surgical and thoracic surgical approaches in a multicenter experience to develop a clinical algorithm and to identify those patients not requiring bony correction but rather alloplastic endoscopic implant correction alone. Methods Patients with deformed rib cages and sternal plates were treated with the Erlangen minimally invasive procedure or a modified Ravitch procedure. For deformities involving the sternal bones only, endoscopically assisted minimally invasive implantation of silastic implants was performed. Results Between 1987 and 2003, 599 patients with a pectus excavatum deformity were treated surgically by the authors’ group. Between 1999 and 2003, 515 patients underwent surgery using the Erlangen minimally invasive repair technique at Friedrich–Alexander University–Erlangen. In addition, 84 patients underwent surgery at the Freiburg University Medical Center. In the current series, 79 patients underwent surgery using the modified Ravitch method. The mean patient age was 20.5 years (range, 3–54 years), and the rate of postoperative relapses was 5%. The findings showed that 73% of the patients judged the aesthetic result as excellent to good, and 20% were satisfied. In contrast, only five patients were suitable for soft tissue augmentation only. Two of these patients in the initial period received custom implants presternally via classical transverse skin incisions, whereas three patients were treated with endoscopic customized implant tissue augmentation. Conclusion Whereas with combined deformity of the sternal plate and the rib cage, a modified Ravitch repair yields good results, the endoscopic soft tissue correction with customized implants helps to avoid unsightly scars, allows for safe hemostasis in the dissection pocket, and leads to enhanced patient satisfaction. In the case of major chest wall deformity with orthopedic and functional relevance, a combination of the minimally invasive procedures (e.g., endoscopic correction and Erlangen repair) seems to show both optimized cosmetic results and maximized functionality.  相似文献   

18.
Following cardiac surgery, approximation of sternum will produce systemic hypotension or elevation of left atrial and central venous pressures. A new criteria for delayed sternal closure is proposed. Sternal closure has to be delayed when mean left atrial or central venous pressures increased over 2 mmHg at the tentative closure. In seven cases (3.5%) of consecutive 201 patients was delayed the sternal closure under the above mentioned state, all survived and received the successful closure later. One of them died of congestive heart failure four months after the operation and one died of the rupture of the ascending aortic pseudoaneurysm eleven months after the initial operation. Microbiological examination of the mediastinal and pericardial contents obtained at the final sternal closure were negative in all cases. Comparing the total cardiopulmonary bypass time, ventricular fibrillation time, and myocardial ischemic time between in the secondary closure group and in the primary closure group, the total bypass time and the ventricular fibrillation time of the former were significantly longer than the latter, but the ischemic time revealed no difference. In conclusions, persistent elevation of left atrial or central venous pressures after cardiac surgery at the tentative sternal closure seems the reliable predictor for the delayed closure of the sternum. Careful post-operative management prevents serious mediastinal infection. Delayed sternal closure is preferable procedure for the patient with brittle hemodynamics after open heart surgery.  相似文献   

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