鸡胸的微创外科治疗

目的 介绍微创治疗鸡胸的手术方法 、并发症和相关临床经验.方法 利用微创Nuss手术的原理行胸骨沉降术治疗6例鸡胸病儿,均为男性,年龄10.5～16岁,平均(13.6±1.94)岁.术前均行CT检查,测量Hailer指数.5例采用Nuss手术的钢支撑架及固定器作为同定架,1例采用国产钛同定架及专用固定器.结果 6例均顺利完成手术,无术中并发症.手术时间80～120 min,平均(104.17±15.63)min;术中出血3～10 ml,平均(5.17±2.56)ml;术后住院5～7天;随访1～11个月.1例术后3个月时同定架脱开,再次手术固定.余无并发症.结论 微创胸骨沉降术矫正鸡胸的手术方法 安全可行,并可以增加胸廓的容积.病儿手术修复的最佳时机为10～16岁.技术方法 的改进和远期效果的评价,还需进一步研究探讨.     

鸡胸的微创外科治疗

Objective Minimally invasive technique was used in the treatment of pectus carinatum. Indication, techni-cal details and perioperative complication are discussed in this paper. Methods From March 2008 to January 2009, 6 patients with pectus carinatum underwent minimal invasive operation by using the principle of Nuss procedure in which pressure applied through a curved steel bar that was placed subcutaneously anterior to the sternum, via lateral thoracic incisions. Preoperative CT scan were performed and Hailer index was used as operative indication. Results The average age of patients was (13.6 ± 1.94) years (range, 10 - 16 years). They were all males. The mean operation time was (104.17 ± 15.63) minutes. The av-erage blood loss was (5.17±2.56) ml. The mean hospital stay was (5.67±0.82) days. Postoperative follow-up was 1 -11 months. Displacement of the stablizer was the only complication that was corrected by further fixation procedure. COnClusion The minimally invasive technique for the treatment of peetus earinatum is safe and effective with minimal complications. It can be selected as an alternative techniques and the appropriate age for this procedure is 10-16 years.     

微创手术矫治鸡胸畸形

目的探讨微创手术矫治鸡胸的手术方法和治疗经验。方法 2010年6月-2014年1月,采用微创手术矫治鸡胸患者30例,其中男21例,女9例;年龄8岁10个月~18岁9个月,平均13岁2个月。24例为初次手术患者,2例为传统鸡胸术后复发患者,4例为正中开胸术后继发鸡胸患者。均为基本对称或轻度不对称鸡胸患者。结果患者均顺利完成手术,无术中大出血及胸腔脏器损伤等严重并发症发生。手术时间42~95 min,平均70 min;出血量4~30 m L,平均10 m L。患者于术后6~10 d出院,平均7 d;均获随访,随访时间9~54个月,平均25个月。术后无伤口感染;7例术后复查胸片时发现轻微气胸,未给予特殊处理,术后1个月复查胸片气胸吸收;1例术后半年因外伤致固定钢丝断裂、钢板移位,重新手术固定。21例术后钢板植入满2年已手术移除钢板。患者均保持良好外观效果,恢复正常活动,无不适表现,患者和家属对矫形效果满意。结论微创手术矫治鸡胸,安全可行,创伤小,耗时较短,近中期随访矫形外观效果满意。     

鸡胸的外科治疗

胸骨向前隆起称之为鸡胸 (pectuscarinatum ,chickenbreast) ,约占胸部畸形的 6 %～ 2 2 % ,男∶女约为 3∶1〔1〕。临床上按照其不同的解剖形状与手术治疗方式 ,将鸡胸分为 3型 ,即船形胸 (keelchest)、球形鸽胸 (pouterpigeonbreast)和单侧鸡胸 (lateralbreast)。中、重度畸形者会对病儿生理及心理发育造成不良影响 ,应手术治疗。临床资料　本组 9例中男 7例 ,女 2例。年龄 3 5～ 16 0岁 ,<6 5岁者 8例。 2 0世纪 90年代初期就诊 4例 ,均为船形胸 ,沿用传统的手术方法 ;90年代后期就诊 5例 ,船形胸 3例 ,球形鸽胸和单侧鸡胸各 1例 ,均用…     

鸡胸的外科修复

我科近年手术矫正鸡胸4例,随访半年以上,近期效果满意。对其诊断,手术方法及适应证进行分析讨论。     

小儿鸡胸的分型及外科治疗

目的：探讨小儿鸡胸的手术时机及手术方法。方法：将１９８２年２月至１９９７年２月收治的１０２例鸡胸病儿有骼特点分为４型,并设计相应的手术方法。随访３个月至１０年,对不同类型及不同年龄鸡胸手术的预后进行分析。结果：Ｉ型（胸骨弓状前凸型）手术效果最佳,其次为Ⅱ型（非对称型）和Ⅲ型（胸骨柄前凸型）,ＩＶ型（胸骨抬举型）较差。应用方差分析结果显示,３～５岁组与６～１５岁组手术满意程度无明显差异,延长随访时间     

微创胸骨沉降术矫治鸡胸

摘要：目的探讨微创胸骨沉降术矫治鸡胸的手术适应证、手术方法、安全性和效果。方法回顾性分析2009年7月至2012年8月上海交通大学医学院新华医院40例鸡胸患者行微创胸骨沉降矫治术的临床资料，其中男39例，女1例；平均年龄14．5（12～22）岁；均为初次手术矫治。所有患者前胸明显向前突出，其中21例患者胸骨呈对称性突出，19例呈不对称性突出。术前检查包括心电图、胸部CT、超声心动图、肺功能，Hailer指数为1．91±0．23，其中16例患者存在轻度限制性通气障碍。所有患者均采用Nuss矫形钢板行微创胸骨沉降术，术后3个月限制剧烈活动，2年后取出矫形钢板。结果所有患者均顺利完成手术，术后胸廓外形明显改善，患者和家属对矫正效果均非常满意。手术时间65～115（82．0±15．6）min，平均出血量〈10ml，术后住院时间3～5（3．5±0．8）d．术后Hailer指数为2．39±0．17，较术前显著增加（P〈0．01）。术后并发症包括伤口感染2例，气胸1例（胸腔闭式引流后好转），皮下积液3例，2例持续疼痛〉14d，围术期未发生严重并发症。40例患者术后随访3～36个月，1例患者因伤口感染提前拆除固定钢板，其余39例患者矫形钢板的位置良好，无钢板移位，无固定片滑脱。其中8例患者已经拆除内固定钢板，未出现鸡胸复发。结论胸廓顺应性较好的青少年鸡胸患者是微创胸骨沉降术的最佳适应证，采用微创胸骨沉降术矫治鸡胸操作简单、安全可靠、创伤小、外形美观，矫形效果满意。     

改进微创技术治疗大龄鸡胸患者的近期疗效

目的 探讨改进微创技术治疗大龄鸡胸患者的可行性及近期结果. 方法 回顾性分析自2009年7月至2011年7月北京军区总医院采用改进微创技术治疗16例大龄鸡胸患者的临床资料,男12例,女4例；年龄(19.8±4.7)岁.鸡胸指数(HI) 2.00±0.23.前胸壁凸起型10例,鸡胸漏斗胸混合型6例.患者仰卧位,在全身麻醉下施行手术.(1)胸骨沉降法:适宜前胸壁凸起型.取胸壁最凸点水平两侧腋中线做小切口,创出横行于前胸壁的胸肌下隧道,将已制备好的矫形板穿过肌下隧道,施压整形后矫形板两端用钢缆与肋骨固定；(2)胸骨抬举及沉降联合法:适宜混合型.用Nuss方法将矫形板置于胸骨最凹陷部位抬举；胸骨角处小切口胸骨截骨和畸形肋软骨切除成形沉降胸骨. 结果 无围术期死亡,16例均顺利完成手术,手术时间(65.0±7.8) min,失血量(20.0±4.2) ml,住院时间(5.0±1.8)d.术后胸廓外形恢复正常,HI 2.8±0.4.胸廓外形和胸部CT影像形状满意.随访16例,随访时间12～30个月,平均随访18个月.其中1例已取出矫形板.疗效优秀13例(81.2％),良好3例(18.8％). 结论 采用改进微创技术矫治大龄鸡胸患者,需要选择恰当的手术术式,可获得良好的近期效果.     

改良微创胸骨沉降术矫正鸡胸的手术配合

12例鸡胸患者接受改良微创胸骨沉降术.结果 手术均顺利完成,随访1～12个月,未发生严重并发症,胸廓塑形良好,效果满意.提出充分的术前准备,密切的术中配合,尤其是游离隧道及拖钢板时密切监测患者的生命体征,备好抢救用药,严格的无菌技术操作,是确保手术患者安全、畸形矫正满意至关重要的环节.     

胸肋沉降术治疗鸡胸

目的:报告18例鸡胸的手术治疗,探讨胸肋沉降术治疗鸡胸的手术方法及治疗效果。方法:1989～2002年收治鸡胸18例,男12例,女6例,对称性11例,非对称性7例;年龄最小5岁,最大13岁,均行胸肋沉降术。非对称性根据具体情况在手术中具体处理。结果:术后矫形外观全部满意。对称性矫形外观良好,非对称性外观较术前改变明显,家长也感到满意。结论:胸肋沉降术是一种比较成熟的鸡胸矫形手术方法,术中灵活运用得当,能够得到满意的治疗效果。     

Minimally invasive thoracoscopic repair of unilateral pectus carinatum

Thoracoscopic repair of pectus excavatum as described by Nuss has become a well established method of repair. However, minimally invasive intrathoracic repair of pectus carinatum has not been reported in literature. We report a case of successful thoracoscopic repair of unilateral pectus carinatum.     

A 5-year experience with a minimally invasive technique for pectus carinatum repair

Purpose

This report describes a 5-year experience with a novel, minimally invasive surgical technique for treatment of pectus carinatum.

Methods

From June 2002 to August 2007, 40 patients underwent operation to correct pectus carinatum by pressure applied through a curved steel bar that was placed subcutaneously anterior to the sternum, via lateral thoracic incisions. The bar is inserted through a polyvinyl chloride tube with the convexity facing posteriorly. The polyvinyl chloride tube is positioned presternally by trocar.Subperiosteal wires attach small fixation plates to the ribs laterally, and the convex bar is secured to the small fixation plates with screws applying manual pressure to the anterior chest wall until the desired configuration is achieved. The compressive elongated bar is attached to the fixation plate with screws. The average age was 14.3 years (range, 10-21 years), and 90% were male. Both symmetric and asymmetric protrusions were treated. Patients whose chest was not malleable, and whose sternum could not be brought to a desirable position with pressure from the operator's hand, were treated by the open or “Ravitch” technique. After 2 or more years, the bar, wires stitches, screws, and fixation plates were removed.

Results

Of 40 patients treated with this procedure, 20 have undergone bar removal with the following results: 10 excellent, 4 good, 4 fair, and 2 poor. Average blood loss was 15 mL. Average length of hospital stay was as follows: implant, 3.8 days; removal, 1.4 days. Patients returned to routine activity 14 days after repair. Average follow-up since primary repair is 2.49 years. In those who have had bar removal, it is 1.53 years. Complications were pneumothorax in 1 patient, treated with chest tub e suction; skin adherence in 8 cases; seroma in 6; wire breakage in 3; persistence of pain in 1; and infection in 1. Technical modifications (selecting younger patients, excluding patients with a stiff thoracic wall, submuscular insertion of the bar, stronger pericostal wire) have been associated with no complications in the last 16 cases.

Conclusions

This experience with a new, minimally invasive technique for the treatment of pectus carinatum shows it to be safe and effective. The correction obtained was highly satisfactory with minimal complications. It should be considered in appropriate cases as an alternative to more invasive techniques.     

Refinements in pectus carinatum correction: the pectoralis muscle split technique

Background

The standard approach for correction of pectus carinatum deformity includes elevation of the pectoralis major and rectus abdominis muscle from the sternum and adjacent ribs. A postoperative restriction of shoulder activity for several weeks is necessary to allow stable healing of the elevated muscles. To reduce postoperative immobilization, we present a modified approach to the parasternal ribs using a pectoralis muscle split technique.

Methods

At each level of rib cartilage resection, the pectoralis muscle is split along the direction of its fibers instead of elevating the entire muscle as performed with the standard technique. From July 2000 to May 2007, we successfully used this technique in 33 patients with pectus carinatum deformity.

Results

After the muscle split approach, patients returned to full unrestricted shoulder activity as early as 3 weeks postoperatively, compared to 6 weeks in patients treated with muscle flap elevation. Postoperative pain was reduced and the patients were discharged earlier from the hospital than following the conventional approach.

Conclusions

The muscle split technique is a modified surgical approach to the parasternal ribs in patients with pectus carinatum deformity. It helps to maintain pectoralis muscle vascularization and function and can reduce postoperative pain, hospitalization, and rehabilitation period.     

微创漏斗胸矫形钢板的技术改进

目的 探讨微创漏斗胸矫形术的矫形器(包括内置钢板及固定片)研究及临床应用.方法 通过查阅大量文献,参考国内外同类器材专利钢板的应用材料,结合最新医用钛合金研究进展,寻求到β型Ti-35Nb-5Ta-7Zr钛合金加工成矫形器.在AG-550电子万能试验机上与另外4种最具代表性的医用生物材料,测试了力学性能,并结合它们的物...     

微创漏斗胸矫形术治疗漏斗胸53例报告

目的探讨微创漏斗胸矫形术（minimally invasive repair of pectus excavatum或Nuss手术）的近期效果。方法53例均在气管插管全麻下手术。双侧胸壁做横行切口，在胸腔镜下将塑形之矫形板由右胸腔经胸骨后穿至左胸腔，翻转矫形板，将胸骨抬起矫正胸骨凹陷，矫形板两侧用固定片固定于肋骨。矫形板放置2年后取出。结果53例均顺利完成手术，手术时间30-240min，平均47min，无术中并发症。术后住院2～14d，平均6．1d。术后疼痛超过1周1例；气胸7例；皮下气肿11例；矫形板旋转3例；单侧固定片滑脱4例；切口感染3例，其中2例被迫将矫形板取出，1例经清创换药伤口愈合。53例随访3-28个月，平均15．6月，优42例，良4例，一般3例，差4例。结论Nuss手术治疗小儿漏斗胸近期效果满意。     

Reactive pectus carinatum in patients treated for pectus excavatum

Purpose

The Ravitch and minimally invasive Nuss procedures have brought widespread relief to children with pectus excavatum, chest wall deformities, over the last half century. Generally accepted long-term complications of pectus excavatum repair are typically limited to recurrence of the excavatum deformity or persistent pain. This study examines the authors' experience with patients who develop a subsequent carinatum deformity within 1 year of pectus excavatum repair.

Methods

The authors retrospectively assessed the charts of all patients diagnosed as having a carinatum deformity subsequent to treatment for pectus excavatum at a tertiary urban hospital. We noted age at original correction of pectus excavatum, time from original correction to diagnosis of carinatum deformity, age at correction of carinatum deformity, complaints before correction, methods of repair, postoperative complications, and we reviewed relevant radiography.

Results

Three patients who underwent pectus excavatum repair between January 2000 and August 2007 developed a subsequent carinatum deformity. Two patients initially underwent minimally invasive Nuss correction of pectus excavatum; 1 patient underwent the Ravitch procedure. Within 1 year of original correction and despite intraoperative achievement of neutral sternal position, a protruding anterior chest deformity resembling de novo pectus carinatum emerged in each patient; we term this condition reactive pectus carinatum. The mean age of patients undergoing initial pectus excavatum repair was 13 years (range, 11-16 years). The pathophysiology of this reactive lesion is not well understood but is thought to originate from reactive fibroblastic stimulation as a result of sternal manipulation and bar placement. Patients who underwent Nuss correction initially were managed with early bar removal. Two of the patients eventually required surgical resection of the carinatum deformity at a time interval of 3 to 6 years after initial excavatum repair. In one patient, the carinatum deformity resolved spontaneously. Neutral chest position and absence of dyspenic symptoms were achieved in all patients.

Conclusions

Reactive pectus carinatum is functionally encumbering and a poor cosmetic complication of either the Ravitch or minimally invasive Nuss procedures. Our experience with reactive pectus carinatum introduces the importance of postoperative vigilance even in patients without underlying fibroelastic disease. Examination of the chest with attention to the possibility of an emerging carinatum deformity, particularly in the first 6 postoperative months, is paramount. A telephone call to the patient at 3 months may be a useful adjunct to clinic visits. An optimal long-term result may be achieved through a combination of early Nuss bar removal or postpubertal pectus carinatum repair.     

Force required for correcting the deformity of pectus carinatum and related multivariate analysis

Objective

To measure the force required for correcting pectus carinatum to the desired position and investigate the correlations of the required force with patients’ gender, age, deformity type, severity and body mass index (BMI).

Surgical correction of pectus carinatum: lessons learned from 260 patients

Background

Patients with pectus carinatum (PC) frequently experience physiologic symptoms, which are often overlooked by physicians. Sparse data have been published regarding the indications for correction of PC and the newer techniques of surgical repair.

Methods

Since 1970, 260 (89% males) symptomatic patients with PC with a mean severity index of 1.81 underwent open surgical correction at the University of California, Los Angeles, Medical Center by 1 surgeon. All patients had experienced dyspnea, reduced endurance, and tachypnea with exertion. Asthmatic symptoms were noted by 22%. The mean age at operation was 18.2 years. Asymmetric protrusion was present in 126 (48%) patients. Combined protrusion of the upper chest and depression of the lower chest was present in 17 patients. Varying degrees of depression on one or both sides of the lower chest was present in 36%. Repair of recurrent PC deformities was performed on 16 patients. Progressively, less costal cartilage was resected over the 37-year period, with the last 181 patients having only short segments excised from both ends of deformed cartilages with suture reattachment. Transverse sternal osteotomy was used on all, and 242 (93%) had a support strut anterior to the sternum for 6 months.

Results

Exercise induced dyspnea, and reduced endurance was improved in all patients within 3 to 6 months after repair. Need for repair of recurrent deformities and resection of mild residual cartilage protrusion was reduced more than 3-fold when less extensive cartilage resection with wire reattachment was used. Postoperative complications in the last 181 patients were minor and less frequent, pain was less severe, hospitalization was shorter (mean, 2.6 days), and postoperative results were better than when more extensive repairs were used in previous years. With a mean overall follow-up of 6.2 years, 97.4% of all patients reported a very good or excellent result.

Conclusions

In this largest reported series of PC repair, progressively less extensive open techniques have resulted in low morbidity, mild pain, short hospital stay, and very good physiologic and cosmetic results.