非胸腔镜剑突下小切口与胸腔镜辅助Nuss手术治疗漏斗胸的临床观察

目的 探讨非胸腔镜剑突下小切口（剑突组）与胸腔镜辅助（胸腔镜组）Nuss手术治疗漏斗胸的不同及优势。方法 2016年至2019年我科收治漏斗胸手术患者59例,平均年龄16±3.82岁,33例行非胸腔镜剑突下小切口Nuss手术,26例行胸腔镜辅助Nuss手术,比较年龄、Haller指数、手术时间,出血量,术后出院时间等。结果 两组患者均获得满意效果,剑突组与胸腔镜组在年龄,Haller指数、手术时间,出血量上均无统计学差异,而剑突组出院时间短于胸腔镜镜组。术后6 h至术后24 h,疼痛感明显增强,而术后48 h疼痛则减轻,而术后24 h剑突组疼痛感较胸腔镜轻,有统计学意义。剑突组术后胸腔积液（33.3%）发生率高于胸腔镜组（15.4%）,而剑突组气胸（27.3%）发生率则低于胸腔镜组（42.3%）。胸腔镜组一例非对称性漏斗胸术后2周出现心包积液,双侧大量胸腔积液,治疗后康复出院,其余患者均平稳。结论 针对对称性漏斗胸患者,非胸腔镜剑突下小切口与胸腔镜辅助Nuss手术,手术时间、出血量等均无明显差异,均可获得满意效果,而针对非对称或复杂漏斗胸,剑突下小切口安全性则更有保证。

Comparative study of non thoracoscopic subaxiphoid small incision and thoracoscopic assisted Nuss surgery in the treatment of pectus excavatum

Objective To investigate the differences and advantages of Nuss surgery in the treatment of pectus excavatum by non thoracoscopic subaxiphoid incision （xiphoid group） and thoracoscopic assisted （thoracoscopic group）. Methods From 2016 to 2019, 59 patients with pectus excavatum were treated in our department, with an average age of 16 ± 3.82 years old. 33 patients underwent non thoracoscopic small incision Nuss operation, and 26 patients underwent thoracoscopic assisted Nuss surgery. The age, Haller index, operation time, blood loss and postoperative discharge time were compared. Results Satisfactory results were obtained in both groups. There were no significant differences in age, Haller index, operation time and blood loss between xiphoid process group and thoracoscopic group, but the discharge time of xiphoid process group was shorter than VATS group. The pain was significantly increased from 6 h to 24 h, after operation, while the pain was alleviated 48 h after operation, while the pain in the 24 xiphoid group was lighter than that in thoracoscopy, which was statistically significant. The incidence of postoperative pleural effusion in xiphoid group （33.3%） was higher than VATS group （15.4%）, while the incidence of pneumothorax in xiphoid group （27.3%） was lower than VATS group （42.3%）. In VATS group, pericardial effusion occurred 2 weeks after operation, and a large number of bilateral pleural effusion occurred. After treatment, the rest of the patients recovered smoothly. Conclusion For patients with symmetrical pectus excavatum, there is no significant difference between non thoracoscopic subaxiphoid incision and thoracoscopic assisted Nuss surgery in terms of operation time and blood loss, which can obtain satisfactory results. However, for asymmetric or complex pectus excavatum, the safety of small incision under xiphoid process is more guaranteed.