漏斗胸矫正术后肺功能远期随访

了解漏斗胸矫正术后肺功能的变化及肺功能能否功能否恢复到正常水平。方法随访２７例泥漏斗胸术后患儿,其中男２４例,女３例,年龄８－１６岁,平均手术年龄是４．９８岁,平均随访时间为６．８９年。     

获得性漏斗胸(附2例报告)

漏斗胸是最常见的前胸壁畸形 ,发病率为 4 .0‰～ 8.0‰ ,病因尚不清楚。笔者报告 2例前胸壁手术后形成漏斗胸的患者并结合文献复习 ,探讨其发生的原因和病理机制。病例报告例 1:女 ,9岁。因先天性心脏病左冠状动脉右心室瘘 ,于 2年前在他院行冠状动脉瘘口缝扎术 ,术后心功能恢复良好 ,但逐渐出现前胸壁凹陷并渐加重 ,参加体育活动易疲乏 ,剧烈活动后喘息而就诊。体检 :胸部正中有一纵行的手术瘢痕 ,前胸壁呈对称的漏斗状下陷 ,肋缘轻度外翻 ,心脏各瓣膜区均未闻及杂音。心电图检查正常。胸部Ｘ线提示漏斗胸畸形 ,胸骨凹陷约 2ｃｍ ,双肺轻…     

NUSS手术治疗小儿漏斗胸的临床效果观察

目的探讨Nuss手术治疗小儿漏斗胸的临床效果。方法采用Nuss手术治疗小儿漏斗胸87例,男62例,女25例,平均年龄5.8岁(3～21岁),3～6岁43例,7～10岁28例,11～16岁9例,17～21岁7例。在胸腔镜监视下,先用弯钳在胸骨凹陷最低点切开胸膜,钝性分离胸膜外胸骨后隧道(避免在导入引导器时损伤心包);于胸骨凹陷最低点右侧肋间最高点穿入引导器至右侧胸腔,经分离的隧道紧贴胸骨至胸骨左侧,于左侧对应的最高点肋间穿出引导器;将矫形钢板凹面朝上导入,翻转180°顶起胸骨;两侧安装固定片,以2-0可吸收缝线将固定片与肋骨膜缝合;缝合肌肉和皮肤,不留胸腔引流管。手术后2年常规取出钢板。结果87例均顺利完成手术,无中转开放手术者,平均手术时间37.6min(24～120min),出血量2～10ml,手术后平均住院时间5.9d(2～9d)。无心包损伤发生。全部病例平均随访29.6个月(3～60个月),疗效满意78例(91.9%),获得改善5例(5.7%),不满意4例,差4例。年龄越小,满意度越高,3～6岁和7～10岁组满意度分别为97.6%、96.4%,而17～21岁组满意度为28.6%,二者差异有显著统计学意义(P<0.01);11～16岁组满意度为77.7%,比17～21岁明显增高(P<0.01),与3～6岁和7～10岁组比较无统计学意义(P>0.05)。结论Nuss手术矫治小儿先天性漏斗胸安全有效,具有损伤小,恢复快,兼顾美容的优点,年龄越小,效果越好。     

儿童漏斗胸手术疗效的早期评估

目的 探讨儿童漏斗胸不同术式间的疗效差异，提出最佳术式。方法 1984年3月-2001年8月对123例漏斗胸先后用肋软骨多处切断上抬胸骨(方法一，n=15)、胸(肋)骨翻转(方法二，n=26)、胸(肋)骨翻转加克氏针固定(方法三，n=14)、改良Ravitch胸骨抬举术(方法四，n=68)进行了手术矫治。结果 术后1年评估疗效，满意率为：方法一40．00％，方法二53．84％，方法三64．28％，方法四80．89％。结论 改良Ravitch胸骨抬举术疗效较高，更适用于儿童，但用作支架的材料尚待改进。     

漏斗胸动物模型的建立

由于病因一直不清,漏斗胸未能复制出相应的动物模型,但先天性心脏病手术后有的患儿发生漏斗胸,提示前胸壁骨折可能与胸壁畸形的发生有关。为此,本研究通过从胸骨旁切断幼鼠下位三对肋软骨以建立漏斗胸动物模型。     

微创Nuss手术治疗小儿漏斗胸

先天性漏斗胸在小儿外科临床较为常见。2006年8月至2007年7月本院采用微创Nuss手术治疗漏斗胸90例,疗效满意,现报告如下。临床资料     

漏斗胸的治疗现状与进展

漏斗胸是儿童最常见的胸廓畸形，它因胸骨下端及相连肋骨下陷状似漏斗而得名。其病因不明，有以下几种学说：①胸肋骨发育不平衡，肋骨挤压胸骨所致。②膈肌脚短，附着胸骨的膈肌向内牵拉所致。③遗传因素。不管何种病因，其结果都造成了胸廓凹陷，影响美观，而且严重影响心肺     

漏斗胸手术方式的选择

目的探讨不同年龄和畸形程度的漏斗胸患儿的手术方式选择。方法本组共38例漏斗胸患儿，其中15例年龄小于7岁的轻、中度漏斗胸，行胸骨上举、胸肋骨成形术，用1根克氏针固定；6例年龄小于7岁的重度漏斗胸和8例年龄7～12岁的轻、中度漏斗胸，行胸骨“V”形截骨、胸肋骨成形术，用1根克氏针固定；5例年龄7～12岁的重度漏斗胸和4例大于12岁的漏斗胸，行胸骨“V”形截骨、胸肋骨成形术，用2根克氏针固定。结果38例中，31例效果满意，胸廓外形满意。3例因内固定物刺激导致皮肤软组织破溃，于术后3个月内取出内固定物而复发，4例有胸廓扁平伴胸前不整。结论“V”形截骨、胸肋骨成形术治疗小儿漏斗胸手术方法简单、并发症少、畸形矫正效果好、符合小儿生理特点；根据不同手术年龄和畸形程度选择不同改进型的“V”形截骨、胸肋骨成形术可尽量减轻对患儿的损伤。     

漏斗胸肋软骨生物力学特性研究

目的：探讨漏斗胸肋软骨生物力学特征。方法：19例漏斗胸患儿肋软骨手术标本经处理后,用日本岛津AG－1000A电子式万能实验机行拉伸、压缩和弯曲试验,载荷精度0．25％,加载速度5mm/min。取年龄相同死于非骨骼肌肉系统疾病的尺体标本作对照。记录应力－应变关系曲线或应力－时间关系曲线并根据该曲线计算平均最大压缩、拉伸、弯曲强度和平均最大应变。结果：病变组拉伸强度、压缩强度、弯曲强度和平均最大应变均小于对照组。在相同的应力作用下,病变组的应变较大。病变组破坏应力也小于对照组。结论：漏斗胸肋软骨生物力学性能有下降,这种改变可能与漏斗胸的形成有一定关系。     

改良Nuss手术纠治小儿不对称型漏斗胸

目的总结胸腔镜辅助下改良Nuss手术纠治不对称型小儿漏斗胸的初步经验。方法2004年6月至2006年7月,我院共施行漏斗胸Nuss手术纠治53例,其中17例为不对称型,男13例,女4例。最小年龄2岁5个月,最大14岁,平均8.9岁。手术在胸腔镜辅助下完成。根据患儿畸形情况,设计个性化钢板形状,并对Nuss手术进行改良。结果17例患儿均顺利完成手术,术中平均失血少于15ml。1例患儿术后胸片显示少量气胸,1例患儿术后胸腔积血,1例患儿术后胸腔积液,无其他并发症。术后平均住院6d。13例获得对称性纠正效果,4例术后单侧稍扁平,畸形矫正满意。结论对不对称型漏斗胸采用个性化钢板弯制技术进行Nuss手术,能取得较好的矫形效果。     

Operative correction of pectus excavatum

The Rehbein operation for pectus excavatum has been in use at the Children's Hospital of Bremen since 1955. This procedure involves presternal sternum fixation: after mobilization of the concavity, the elevated sternum is held in a position of slight overcorrection by steel splints and metal bands that are left in place for 3 years. The operation is most likely to succeed in children between 6 and 8 years or over 12 years of age. Surgery is indicated for all severe deformities; moderate forms should be operated upon only when ventilation disturbance, cardiac displacement, or psychological disorders are present. The operative results with this procedure are comparable to those achieved by other operations: we had good results in 69.2%, satisfactory in 18.3% and poor in 12.5% of cases.     

胸骨吊牵术治疗小儿漏斗胸的临床研究(附217例报告)

目的探讨胸骨吊牵术治疗小儿漏斗胸的方法和疗效。方法1990年9月～2006年12月我院收治217例漏斗胸患儿,平均年龄2.3±0.8岁(1.5～5岁);胸骨下端凹陷范围在5～10cm×5～10cm,凹陷深度在1.5～4cm,均于气管插管和静脉复合麻醉下,于前胸部做纵形小切口,应用自行研制的胸骨吊牵架悬吊胸骨。结果217例患儿中,治愈212例(97.5%),好转5例(2.5%),治愈患儿的心肺功能达到正常,易患症状消失。结论采用胸骨悬吊术治疗小儿漏斗胸操作简单,创伤小,经济实用,能明显改善小儿漏斗胸症状。以3岁前手术为佳。     

Echo planar imaging of an infant with pectus excavatum

Echo planar imaging has enabled us to image safely and without sedation the thorax of an infant with pectus excavatum deformity. The heart was displaced into the left side of the thorax, and the right lung was calculated to be 1.6 times larger than the left lung.     

Upper sternal depression following Lorenz bar repair of pectus excavatum

An upper sternal depression following Lorenz bar repair of pectus excavatum (PE) represents a partial recurrence and poses a difficult problem for the surgeon. There is no published experience detailing the management options or best course of therapy for this complication. This study presents our institutional experience in treating eight patients with this specific subtype of recurrence and we discuss intraoperative considerations which aid in the identification and better management of this deformity. A retrospective review (1997-2006) of patients undergoing primary repair of PE with a Lorenz bar procedure identified eight patients who experienced upper sternal depression with the bar still in place following initial repair of PE. All patients were revised with the insertion of a second bar to elevate the upper sternal depression. Data collected for each patient included demographics, preoperative symptoms, operative characteristics, and postoperative outcomes. The mean age at the time of Lorenz bar repair and surgical revision was 20.8 +/- 9.5 and 21.5 +/- 10.1 years, respectively. A majority of patients (87.5%) were male. The mean time to reoperation was 23.8 +/- 11.8 months. Following this second procedure, no patient has experienced bar displacement, recurrence of the upper sternal depression, or has required a third procedure. Our limited experience supports the use of a second Lorenz bar in the treatment of upper sternal depression after bar correction of a PE deformity. Appropriate recognition and treatment of this entity will advance patient outcomes and satisfaction after surgery for PE deformities.     

Radiological assessment of children with pectus excavatum

Objective To assess what degree of chest wall deformation changes statistically reliably after surgery, using pre-and postoperative radiological examination data. Methods Radiological chest examinations were performed for 88 children before and after remedial operations. Pre-and postoperative chest radiograph and CT were performed to measure transversal chest width; sagittal left chest side depth, sagittal right chest side depth, sternovertebral distance, and vertebral body length. Derivative indices were also estimated: Vertebral index (VI), Frontosagittal index (FI), Haller index (HI) and asymmetry index. Computerized assessment of data was used. For statistical analysis, the software “Statistica 6.0” was used. Results Postoperatively VI increased approximately by 2.37±2.72, FI decreased by 4.60±4.34, and HI value increased approximately up by 0.45±0.49. Statistically significant deformation index difference before and after surgery was not detected when VI was below 26.2 (p=0.08), FI was above 32.9 (p=0.079) and HI was less than 3.12 (p=0.098). Conclusion Preoperative CT and X-ray assessment of chest wall deformation degree is important for pediatric patients. The following deformation indices are indications for surgical treatment: VI>26, FSI<33 and HI>3.1.     

Early complications of the Nuss procedure for pectus excavatum: a prospective study

The Nuss procedure is a minimally invasive method for the correction of pectus excavatum, with several centers reporting its successful application. Complications related to the Nuss procedure are not uncommon and life-threatening complications have been reported. This study focuses on the incidence and management of complications in a series of 167 children and adults with funnel chest corrected by Nuss procedure. Guidelines and strategies to avoid the most common and typical complications are proposed. All patients with funnel chest, operated between April 2000 and 2006 were evaluated prospectively. Our surgical approach involved the submuscular insertion of the pectus bar under right-sided thoracoscopic control. The bar was secured in most cases with one stabilizer on the right side on the underlying rib to prevent bar displacement. Postoperative pain was primarily managed by epidural catheters. All data in the patient report forms was prospectively entered in a database. All complications were documented and classified into major or minor complication. A major complication was noted, if an organ injury occurred or if a significant surgical intervention became necessary. A minor complication was documented, if either an endoscopy or an evacuation of fluid or gas from the thorax by puncture were necessary. One hundred and sixty seven patients (136 males and 31 females) with a mean age of 16.3 (range 5-40 years) were included in this study. Major complications occurred in seven patients (4.2%) and consisted of one intraoperative heart perforation, one piercing of the liver with the trocar, bar infections (n = 2) and significant bar displacement (n = 3). Minor complications were seen in 122 patients (73.1%) and consisted of breakage of wires used to secure the lateral stabilizer plate (n = 48), pleural effusions (n = 28), intraoperative rupture of the intercostal muscle (n = 15), pericardial tears without clinical significance (n = 7) and lung atelectasia (n = 4). Major complications related to the Nuss procedure were rare but preventable and could mainly be attributed to the learning curve. Most minor complications can be avoided by changing the technique, e.g. fixation of the bar and the stabilizer onto the underlying rib, use of PDS cords instead of metal wires to fix the bar and the stabilizer, entrance into and exit of the thorax medial to the rim of the pectus excavatum, etc. Some complications are related to the technique, such as minor pleural effusion or remaining gas in the thorax. Clear guidelines in regard to the technique are presented to prevent the majority of complications and thereby shorten the learning curve.     

小儿漏斗胸Nuss手术对胸廓影响的研究

目的 探讨小儿漏斗胸Nuss手术对胸廓的影响.方法 对2004年至2008年采用Nuss手术治疗的33例漏斗胸患儿,主要利用超声及螺旋CT检查进行术后随访.项目包括:肋骨、肋软骨、胸壁第1至第6对肋骨与软骨关节(CCJ)、胸肋关节(CSJ)以及胸廓外观.结果 2例钢板移位;4例(12.1%)术后出现胸廓畸形;1例术后3年4个月发现右侧第四肋软骨胸骨端陈旧性骨折;1例术后1周发生右侧第五肋软骨横断骨折;8例(24.2%)术后近期随访发现不同程度的CSJ及CCJ的损伤;6例(18.2%)钢板平面以下的胸廓下陷;1例发现左侧第五肋软骨斑点状骨化.结论 Nuss手术虽然优点颇多,但也存在明显不足.利用钢板的外力强行将凹陷的胸骨顶起,对胸廓是一种创伤,该创伤累及胸廓的关节、肋骨、肋软骨,使CSJ和CCJ不同程度分离、移位,肋软骨骨化、肋软骨骨折以及胸廓畸形等.     

Anterior thoracoplasty stabilized with a resorbable,self-reinforced poly-L-lactide acid plate in the correction of pectus excavatum

Anterior thoracoplasty stabilized with a resorbable, self-reinforced poly-L-lactic acid (SR-PLLA) plate was performed on three children to correct pectus excavatum deformity. The rib cartilages of the deformed region were resected subperichondrally and a transverse sternotomy was performed above the level of the deformed part of the sternum. The deformed sternum was elevated and fixed with a 2.5×8×150-mm SR-PLLA plate placed transversely under the sternum. Recovery of all the patients has been uneventful and no recurrence of the deformity has occurred.     

Cardiac perforation by a pectus bar after surgical correction of pectus excavatum: case report and review of the literature

Pectus excavatum (PE) is a congenital sternal depression. The two most popular methods of correction are the highly modified Ravitch repair (HMRR) and the Nuss procedure. Presented here is a case of PE surgical correction in a 17.5-year-old male, beginning with the Nuss technique and converting to the HMRR during surgery, due to unsatisfying results. The procedure inadvertently culminated in perforation of the heart and lungs by the inserted pectus bar, with aggravation of the damage by resuscitation efforts. This article analyzes the chain of events leading to the patient’s death and reviews the literature on the subject. There are no sources of support for the work in the form of grants, equipment, drugs, or any combination of these.