儿童漏斗胸合并先天性心脏病的纠治

目的 探讨儿童漏斗胸合并先天性心脏病的同期手术的可行性及手术方法。方法 采用改良Ravitch术式对 11例漏斗胸合并先天性心脏病患儿在常规体外循环手术后施行了同期纠治术,其中男7例,女4例,平均5.4岁;3例继发孔房间隔缺损,6例室间隔缺损,1例法洛四联症,1例动脉导管未闭,术前心功能Ⅰ级4例,Ⅱ级6例,Ⅲ级1例。心内矫治术操作毕,放置有胸腔引流管。结果 所有患儿均平稳地渡过了体外循环。术中主动脉阻断时间、体外循环时间、术后的出血和住院时间与同期类似体外循环手术患儿相比差异无显著性意义(P>0.05),术后循环 18～48 h拔除气管插管、48～72 h拔除胸腔引流管,无术后感染、肺不张等并发症,未见明显二氧化碳潴留。漏斗容积由术前的(26.09±5.54)ml降到了(6.55±1.37)ml。结论 同期手术术后的过程是平稳的,避免了再次手术的麻醉及在胸骨劈开心内直视手术后行漏斗胸纠治所带来的困难,手术结果证明是安全和满意的。     

改良Ravitch手术治疗先天性漏斗胸

漏斗胸是最常见的先天性胸廓畸形 ,其前胸壁向后凹陷不仅影响美观 ,而且还可导致心、肺功能障碍、继发脊柱侧弯 ,对患儿产生心理上的影响。我们通过 10年的临床观察 ,就改良Ｒａｖｉｔｃｈ手术治疗先天性漏斗胸报告如下。资料和方法一、一般资料从 1990～ 1999年 ,我们采用改良Ｒａｖｉｔｃｈ手术治疗先天性漏斗胸 86例 ,男 5 9例 ,女 2 7例。年龄 2岁 5个月至17岁 (平均 5岁 3个月 )。漏斗胸指数0 .18～ 0 .4 0 (平均 0 .2 86 )。 2 0例患儿作了ＣＴ扫描 ,均表现有心脏受压 ,连同纵隔一起向左侧胸腔移位 ,胸骨向右旋转。合并先天性心房间隔…     

改良胸骨翻转术治疗小儿先天性漏斗胸20年经验

目的总结近20年采用改良胸骨翻转术治疗先天性漏斗胸120例的经验。方法1985～2004年，手术治疗先天性漏斗胸120例，男98例，女22例，年龄2～15岁，体重10-28kg。有反复呼吸道感染史48例，活动耐量减低45例。心电图有不完全性右束支传导阻滞38例，心室肥厚26例，窦性心律失常31例，T波改变或心肌劳损55例。X线胸片均显示有不同程度的心脏左移。肺功能检查有限制型通气障碍24例。漏斗胸指数（FI）大于0．3有43例，FI在0．2～0．3之间有71例，FI小于0．2有6例。结果全组病例术后均见明显效果。早年1例发生胸骨缺血坏死。肺不张和／或肺部感染6例，胸腔积液3例，伤口感染2例，均痊愈出院。术后住院7～40d（平均10d）。随访1～15年，胸骨呈正常平坦，无一复发。结论改良胸骨翻转术治疗先天性漏斗胸近远期效果满意。     

钢板支架矫治小儿先天性漏斗胸

目的：　观察特制钢板对小儿先天性漏斗胸的矫治效果。方法：　将二侧凹陷的肋软骨作部分切断直至肋骨与肋软骨交界处使凹陷的肋软骨上抬无阻力感,采用特制钢板支架,将钢条二翼分别插入两侧第4或第5肋骨锁骨中线处的肋骨骨髓腔内,用固定钢板将二根钢条固定,用钢丝将胸骨固定在钢板上,使胸骨保持平整。结果：　 12例手术效果满意,胸骨至脊柱椎体间的最小距离从术前的(4 .0±1.1)cm增加到(5.9±1.1)cm。结论：　采用特制钢板支架矫治小儿先天性漏斗胸,术式操作简便,损伤范围小,矫治效果满意。     

同期外科治疗漏斗胸合并先天性肺囊肿

我院于1999年3月2004年2月期间收治了4例漏斗胸合并先天性肺囊肿的患儿，现报告如下。     

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。     

儿童先天性漏斗胸合并先天性心脏病的同期手术治疗策略探讨

目的 探讨儿童先天性心脏病(congenital heart disease,CHD)合并漏斗胸最佳的治疗策略。方法 回顾性分析2007年7月到2018年5月间于湖南省儿童医院住院治疗的17例先天性CHD合并漏斗胸患儿的资料,男10例,女7例,年龄(4.5±2.7)岁,年龄范围1～12.7岁,体重(14.5±5.2)kg ,体重范围7.5～27.5 kg。其中单纯室间隔缺损4例,单纯房间隔缺损8例,室间隔缺损合并房间隔缺损3例,室间隔缺损合并房间隔缺损、动脉导管未闭1例,室间隔缺损合并肺动脉高压1例。根据年龄及漏斗胸程度,分别接受游离提拉胸骨、自制胸骨抬举装置、NUSS钢板的治疗,CHD分别接受体外循环下心内直视手术(经胸骨正中切口或右腋下直切口)或经皮及经心导管封堵治疗。结果 17例患儿均接受同期手术矫治,心内畸形矫治及漏斗胸均矫治成功,住院时间(13.2±4.8)d,住院时间范围为(8～25)d。有2例切口延期愈合,1例术后左侧少量胸腔积液,无手术死亡、大出血及胸腔脏器损伤、排异反应等并发症。结论 依据患儿的特点,选择个体化的方案予以同期矫治儿童CHD合并漏斗胸,可避免多次手术、麻...     

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。     

Indications for surgical treatment of funnel chest by chest radiograph

Forty-seven children with funnel chest (FC) who underwent sternal elevation and 210 normal children were examined to determine the indications for surgical treatment using the vertebral index (VI) and frontosagittal index (FSI). In normal children VI gradually increased and FSI gradually decreased with age. Both indices changed significantly at 3 years of age. Although the VI of FC patients decreased significantly from 33.8 ± 7.6 (n=40) to 24.4 ± 3.9 (n=38) postoperatively (P < 0.0001), it was significantly larger than that of normal children over 3 years of age (20.2 ± 2.2, n=150) (P < 0.0001), and although the FSI of FC patients increased significantly from 22.0 ± 7.0 (n=40) to 34.5 ± 6.5 (n=38) postoperatively (P < 0.0001), it was significantly smaller than that of normal children over 3 years of age (41.1 ± 4.0, n=150) (P < 0.0001). Since many patients had a thin and flat chest despite excellent correction, their postoperative indices were not normal. There was a correlation between VI and FSI in normal children and a high degree of correlation between VI and FSI both before and after operation in FC patients. We conclude that a VI of more than 27 and/or a FSI of less than 29 are indications for surgical treatment based on the mean VI + 3SD and FSI − 3SD of normal children over 3 years of age. These values are almost equal to the mean VI − SD and FSI + SD of patients with physical, cosmetic, and/or psychological disturbances. However, it is not necessary to measure both indices simultaneously. Postoperative VI and FSI did not always reflect the degree of chest-wall depression in FC patients because of their flat chests. Accepted: 25 July 2000     

Late-onset hemothorax after the Nuss procedure for funnel chest

A 4-year-and-3-month-old boy with funnel chest underwent the Nuss procedure. He had an uneventful intraoperative and postoperative course, and was discharged on the tenth day of hospitalization. He developed chest pain while playing on the 29th day after surgery, and was diagnosed with right hemothorax. He was followed conservatively and the hemothorax disappeared.     

Adrenocortical function in children with connective tissue syndromes and funnel chest deformation

Measurement of the content of C-21-corticosteroids in the diurnal urine by thin-layer chromatography has demonstrated that in children with isolated and syndromal forms of funnel-like chest deformation, grades II and III, adrenocortical function is decreased. In preschool children, such a decrease is accompanied by proneness to the tense biosynthesis of glucocorticoids. Children with congenital hereditary connective syndromes manifest adrenocortical dysfunction, most characteristic of Marfan's syndrome, and, to a less degree, of Ehlers-Danlos syndrome and unclassified complex of developmental defects with the Marfan-like phenotype. In view of this fact, the children with Marfan's, Ehlers-Danlos syndromes and with the unclassified complex of developmental defects with the Marfan-like phenotype and children with funnel-like chest deformation, grades II and III, should be given glucocorticoid hormones in stressful conditions (severe diseases, traumas, operations).     

先天性心脏病患儿血浆脑钠肽水平与左心功能的关系

目的：探讨先天性心脏病（先心病）患儿血浆脑钠肽（BNP）水平与左心功能的相关性及其临床意义。方法：回顾性分析41例先心病患儿的临床资料,根据有无合并充血性心力衰竭（CHF）将其分为2组：一组为合并CHF组（n=21）,另一组为无合并CHF组（n=20）。用化学发光免疫分析法测定血浆BNP水平,超声心动图测定左室射血分数(LVEF)。结果：①先心病合并CHF组患儿血浆BNP水平为1353（926,2978）pg/mL,显著高于先心病无合并CHF组［149（75,242）pg/mL］（P<0.01);先心病合并CHF组患儿LVEF为60（53,65）%,显著低于先心病无合并CHF组68（64,72）%（P<0.01)。②先心病患儿血浆BNP水平与LVEF呈显著负相关(r=-0.652,P<0.01)。结论：BNP可作为反映左心功能受损的敏感指标,与心功能状态有明显相关性,其检测对先心病合并CHF患儿左心功能的判断具有重要意义。