微创外科治疗成人漏斗胸疗效观察

目的通过比较手术前后漏斗胸患者心功能和心脏形态,探讨前胸壁凹陷畸形对心脏影响及微创外科治疗疗效。方法 2009年8月-2010年12月,采用微创外科矫治102例成人漏斗胸患者。男84例,女18例;年龄18～57岁,平均23.4岁。初次手术95例,二次手术7例。漏斗胸分型:Ⅰ型59例,Ⅱ型43例。漏斗胸指数(hallerindex,HI)为4.59±1.51。42例出现临床症状,19例出现心脏体征。术前胸部CT检查示,患者心脏均受压,心脏移位74例。超声心动图检查左室射血分数(left ventricular ejection fraction,LVEF)为68.9%±6.2%。结果患者矫治手术均顺利完成,无死亡及严重并发症发生。102例均获随访,随访时间12～28个月,平均21个月。术后患者临床症状及心脏体征均消失。术后12个月HI为2.70±0.33,与术前比较差异有统计学意义(t=5.83,P=0.00)。参照Nuss等的方法评定胸廓形状,获优99例,良3例。术后12个月胸部CT检查示101例完全解除心脏压迫,1例心脏仍轻度受压;心脏位置恢复正常。心电图检查示4例术前异常患者恢复正常。超声心动图检查示LVEF为70.5%±4.8%,与术前比较差异无统计学意义(t=1.08,P=0.30)。结论成人漏斗胸前胸壁凹陷畸形对心脏的影响主要是压迫和推移,微创外科治疗可有效解除心脏压迫,消除临床症状。

EFFECTIVENESS OF MINIMALLY INVASIVE SURGERY FOR PECTUS EXCAVATUM IN ADULTS

Objective To investigate the effect of anterior chest wall depression on the cardiac function and theeffectiveness of minimally invasive surgery for pectus excavatum by comparing cardiac function and morphology between preandpost-operation.Methods Between August 2009 and December 2010,102 adult patients with pectus excavatum weretreated with minimally invasive surgery,including the primary operation in 95 cases and the reoperation in 7 cases.There were84 males and 18 females,aged 18-57 years(mean,23.4 years).The haller index(HI) was 4.59 ± 1.51.Of 102 patients,59 wereclassified as pectus excavatum type I and 43 as type II;42 had clinical symptoms and 19 had the physical sign of heart.Thepreoperative chest CT examination showed cardiac compression in all patients and heart displacement in 74 patients.The leftventricular ejection fraction(LVEF) was 68.9% ± 6.2%.Results The procedure was successful in all patients,and no deathor serious complication occurred.The patients were followed up 12-28 months(mean,21 months).The clinical symptomsand cardiac physical sign of the patients disappeared after operation.HI was 2.70 ± 0.33 at 12 months after operation,showingsignificant diff erence when compared with preoperative HI(t=5.83,P=0.00).According to Nuss’s evaluation method,the resultswere excellent in 99 patients and good in 3 patients.CT examination showed complete relief of cardiac compression in 101 patientsand mild cardiac compression in 1 patient;the heart position was normal at 12 months after operation.Electrocardiogramreturned to normal in 4 patients having abnormal electrocardiogram.LVEF was 70.5% ± 4.8% after operation,showing nosignificant diff erence when compared with preoperative LVEF(t=1.08,P=0.30).Conclusion The main effects of pectusexcavatum in adults on heart are compression and displacement.Cardiac compression may be relieved efficiently and thepatient’s clinical symptoms can be abated by minimally invasive surgery.