胸腔镜辅助漏斗胸矫形术治疗先天性漏斗胸32例临床分析

目的 观察胸腔镜辅助漏斗胸矫形术治疗先天性漏斗胸的临床效果.方法 采用胸腔镜辅助漏斗胸矫形术治疗漏斗胸患者32例,术中通过右胸切口放置矫形钢板l根28例,2根4例;固定器放置在右侧22例,两侧10例.结果 32例均顺利完成手术,平均手术时间55 min,出血量1.8～12.0 mL,术后平均住院7d;优29例,良3例;并发切口感染1例,经对症治疗痊愈.出院后随访1～5年,患者活动正常,钢板无移位,胸廓外形满意.结论 胸腔镜辅助漏斗胸矫形术治疗先天性漏斗胸创伤小、出血少、恢复快、效果满意,方法安全、可靠,值得临床应用.     

电视胸腔镜室间隔缺损修补术67例报告

目的 :报告电视胸腔镜下室间隔缺损修补术 6 7例的结果。方法 :2 0 0 0年 6月至 2 0 0 2年 5月 ,行右侧胸壁打孔电视胸腔镜下室间隔缺损修补手术 6 7例 ,其中男性 36例 ,女性 31例 ,年龄 3～ 39岁 ,体重 13～ 6 8kg。室缺直接缝合 6 2例 ,涤纶补片修补 5例 ,同时行三尖瓣成形 5例。结果 :术中扩大切口 2例 ,室缺残余漏 1例 ,二次开胸止血 1例 ,手术时间 3 0～ 5 6h ,平均 3 1h。体外循环时间 6 2～ 15 2min ,平均 98min ;升主动脉阻闭时间 16～ 5 2min ,平均 2 8min。术后患者恢复顺利 ,治疗效果满意。结论 :电视胸腔镜下室间隔缺损修补术是可行的 ,安全的。     

胸腔镜室间隔缺损修补术初步经验

目的 总结胸腔镜室间隔缺损修补术的经验。方法采用右侧胸壁打孔电视胸腔镜行室间隔缺损修补手术71例，其中男性38例，女性33例，年龄3～39岁，体重13～68kg。室缺直接缝合66例，涤纶补片修补5例，同时行三尖瓣成形5例。结果术中扩大切口2例，室缺残余漏1例，二次开胸止血1例，手术时间2．5～5．6h，平均3．6h。体外循环时间62～152min，平均是97min；升主动脉阻闭时间16～52min，平均28min。术后患恢复顺利，治疗效果满意。结论经过一定时间的训练学习，完全镜视下室间隔缺损修补术是可行的。     

胸腔镜室间隔缺损修补术初步经验

目的 总结胸腔镜室间隔缺损修补术的经验。方法 采用右侧胸壁打孔电视胸腔镜行室间隔缺损修补手术71例，其中男性38例，女性33例，年龄3-39岁，体重13-68kg。室缺直接缝合66例,涤纶补片修补5例，同时行三尖辨成形5例。结果 术中扩大切口2例，室缺残余漏1例，二次开胸止血1例，手术时间2．5-5．6h，平均3．6h。体外循环时间62-152min，平均是97min；升主动脉阻闭时间16-52min，平均28min。术后患恢复顺利，治疗效果满意。结论 经过一定时间的训练学习，完全镜视下室间隔缺损修补术是可行的。     

改良Nuss手术矫治小儿漏斗胸

目的观察无胸腔镜辅助、钢板单侧固定Nuss手术矫治小儿漏斗胸的疗效。方法42例漏斗胸患儿在无胸腔镜辅助下,钢板单侧固定。结果42例均顺利完成手术。手术时间30~50 min,平均47 min,无术中并发症。术中出血量〈10 ml。关胸前充分张肺并用吸引器吸出胸腔内气体,未放置胸腔闭式引流。1例术后气胸者经空针穿刺抽气后即缓解,1例术后轻度皮下气肿,1 d后自行消失。术后住院5~7 d,平均5.6 d。除1例钢板移位再次手术外,其余41例胸廓畸形矫正效果满意。42例均获随访,时间1~32个月,均无不适,活动量如同龄正常儿童,无伤害事件发生,其中4例已取出Nuss钢板,矫形效果满意。结论改良Nuss手术矫治漏斗胸除具有微创、美观、效果可靠等优势外,同时可以减轻手术创伤,简化手术程序,缩短手术时间,减轻患者经济负担。     

剑突下小切口辅助克氏针固定在婴幼儿漏斗胸矫治修复中的应用价值

目的 探讨剑突下小切口辅助克氏针内固定在婴幼儿漏斗胸矫治修复中的应用价值.方法 选择漏斗胸婴幼儿50例,通过剑突下小切口辅助克氏针固定行改良Nuss手术,观察其手术效果及并发症情况.结果 50例患儿均顺利完成手术,手术时间30～50 min,术中出血量(10±3)mL;术后早期并发气胸1例、肋间血管损伤2例,采用相应处理治愈,无晚期术后并发症.术后住院(6.0±1.5)d,随访3～24个月,胸廓畸形矫正满意.结论 剑突下小切口辅助克氏针内固定在婴幼儿漏斗胸矫治修复中安全可行,矫形效果较好.     

非胸腔镜下Nuss手术的临床应用

目的对比胸腔镜辅助与非胸腔镜辅助在Nuss手术矫治漏斗胸中的应用,探讨其价值。方法2009年6月至2014年12月同期行Nuss手术104例,排除严重不对称漏斗胸、极重度漏斗胸、复发性漏斗胸、有并发症的漏斗胸,其中87例纳入研究。男56例,女31例,年龄4岁2个月至14岁5个月,平均7岁8个月。胸腔镜辅助42例,非胸腔镜辅助45例。比较两种手术在手术创伤、并发症及手术效果的优劣。结果两组患者均顺利完成手术,两组手术时间、术中出血量有统计学差异;两组住院时间、手术效果、并发症无统计学差异。随访12-24个月,支撑杆无移位、翻转,胸廓塑形满意。结论 Nuss手术矫治儿童漏斗胸非胸腔镜辅助,胸膜外入路,安全可行,手术创伤更小,微创效果更好。     

微创漏斗胸矫治术围手术期护理

漏斗胸是胸廓全体发生变形的先天性畸形,患病率0.1%-0.3%,3岁以上漏斗变形仍存在者为真漏斗胸。外科手术矫形是唯一有效的治疗方法,Nuss手术为胸腔镜辅助下微创漏斗胸矫正术,由美国Nuss等于1997年向美国小儿外科学会介绍,它使漏斗胸的矫治进入了微创时代,并引起国际同行的兴趣。我院从2008年3月。2009年5月共收治漏斗胸患者10例,在原Nuss手术基础上稍做改动,在无胸腔镜下行双侧胸壁及剑突下三切口手术,效果良好,现将护理体会报道如下。     

完全胸腔镜下手术治疗先天性室间隔缺损50例的体会

目的 总结50例完全胸腔镜下室间隔缺损修补手术的临床疗效.方法 选取50例先天性室间隔缺损患者,应用股、动静脉建立体外循环,右侧胸壁打“3孔”,在完全胸腔镜下行室间隔缺损修补术,观察手术效果.结果 50例先天性室间隔缺损患者均在完全胸腔镜下顺利完成室间隔缺损的修复,手术时间3.0～5.8（3.5± 1.3）h,体外循环时间60～152（110±25）min,升主动脉阻断时间25～98（55±15）min,术后呼吸机辅助时间3.0～6.5（3.0±1.6）h,监护室停留时间14～36（15.0±8.5）h,术后胸液引流量58～230（65± 19）ml,术后自行下床时间15～30（20.0±7.5）h,术后住院4～10（5.0± 1.5）d.术后1周和3个月复查心电图均为窦性心律,无传导阻滞出现;心脏彩超示室间隔未见残余分流,心功能正常;胸部X线片示右侧肺部、胸廓未见明显异常.结论 完全胸腔镜下室间隔缺损修补手术是安全有效的,具有创伤小、疼痛轻、术后恢复快等优点.     

胸腔镜辅助小切口手术治疗老年人胸部肿瘤

目的 探讨胸腔镜辅助小切口手术治疗老年人胸部肿瘤的手术方法及应用价值。方法 应用胸腔镜辅助小切口手术治疗老年人胸部肿瘤356例，其中肺癌228例，肺部良性肿瘤23例，食管癌62例，纵隔肿瘤39例，胸膜肿瘤4例。结果 全组无手术死亡，食管癌手术时间3．5～4．5h，平均4．0h；其他手术时间0．5～3．5h平均2．0h。术中延长手术切口至12cm 23例，占6．5％，均为中央型肺癌患者，需作支气管或肺血管成形。开胸时间5～12min，平均8min；关胸时间15～30min，平均23min。开胸过程出血量少于30ml，切口均Ⅰ期愈合。胸腔引流时间2～7d，平均2．5d、住院天数5～19d，平均11．2d。结论 胸腔镜辅助小切口手术治疗老年胸部肿瘤具有创伤小、恢复快、出血少，对心肺功能影响小，开关胸时间短，术后并发症少，手术适应证更广等优点。     

Pectus Excavatum: Uncommon Electrical Abnormalities Caused by Extrinsic Right Ventricular Compression

We report a case of pectus excavatum associated with ventricular tachycardia provoked by exercise in a 19‐year‐old man. Although this chest deformity has been associated with supraventricular dysrhythmias, documented ventricular tachycardia has only been reported once. Our patient's ventricular dysrhythmia was treated by surgical correction of his pectus excavatum only, and at 3 years follow‐up he has had no recurrence of his ventricular tachycardia.     

Cardiac function before and after surgery for pectus excavatum

A 2006 meta-analysis concluded that thoracic surgery for pectus excavatum (PE) significantly improves cardiovascular function. However, that analysis was flawed by a high level of heterogeneity in the outcomes and inappropriate methods in 5 of the 8 publications analyzed. Therefore, a search of the published research from 1965 to the present was conducted, and only 5 publications were found that reported studies of cardiac function before and after operation, including 118 patients and 82 unoperated controls. Cardiac function was studied most frequently by echocardiography, despite the limitations imposed by the abnormal anatomy of pectus excavatum, but only studies that did not report cardiac or left ventricular dimensions or output were excluded. Studies using indirect estimates on the basis of oxygen pulse, which depends on several other variables, were not included. No improvements were found in left ventricular size, stroke volume, and cardiac output after surgery in 4 of 5 studies, using radionuclides, 2-dimensional echocardiography, radiographic planimetry, and cardiac output by the Fick method. Only a single study, with volumes calculated by squaring the diameter of the left ventricle from M-mode echocardiography, reported an increase (22%) in left ventricular stroke volume after operation, but that increased (17%) in the investigators' unoperated controls. This and 2 other studies used in this meta-analysis were also included in a meta-analysis conducted by Malek et al. In a fourth study, Malek et al included only the first study that found an improvement, but the final study reported no improvement. In conclusion, there is no reliable documentation of improved cardiac function from thoracic surgery for pectus excavatum.     

Coronary sinus type atrial septal defect in a child with pulmonary atresia and Ebstein's anomaly

At birth an infant was found to have an unusual series of abnormalities with a coronary sinus type atrial septal defect complicating pulmonary atresia with an intact ventricular septum and Ebstein's anomaly. The functionally important anomalies were diagnosed by echocardiography and cardiac catheterisation. The coronary sinus defect and Ebstein's anomaly were detected only at necropsy. Although only a single case, the features of this heart favour Bull's revised classification of pulmonary atresia.     

胸腔镜辅助Nuss手术治疗小儿漏斗胸

目的总结42例电视胸腔镜辅助微创NUSS手术的处理经验,探讨NUSS术后疗效和并发症的预防和治疗。方法 2006年12月至2010年12月共施行了42例电视胸腔镜下NUSS手术治疗漏斗胸,其中男34例,女8例;传统手术后复发1例。结果 42例患者顺利完成手术,均于术后6 d内出院。手术时间35~95 min,平均52 min,手术出血均小于20 ml。切口感染1例。随访期间1例术后2月钢板移位,至2010年12月,已有15例术后满2年患者取出支撑板,胸廓外观满意。结论 NUSS手术具有微创、美观、手术时间短、操作简单等优点,电视胸腔镜辅助可增加安全性,近期效果满意,术后宣教可减少并发症。     

Carbon dioxide insufflation aids video-assisted thoracic surgery in a young child

A 3-year-old girl with pectus excavatum successfully underwent exploration using video-assisted thoracic surgery. A complete pericardial defect was identified. The lung was kept totally collapsed during the procedure using low-flow (1 L/min), low-pressure (7 mmHg) carbon dioxide insufflation. This technique is expected to be a safe adjunct to thoracoscopic procedures in infants and small children.     

Coexistence of congenital heart anomalies with noncompaction of the ventricular myocardium

Noncompaction of the ventricular myocardium (NVM) is a rare cardiac anomaly which can lead to the development of cardiomyopathy. NVM can be isolated or associated with congenital heart anomalies such as ventricular septal defect, atrial septal defect, pulmonic stenosis, bicuspid aortic valve, and Ebstein anomaly. NVM usually presents with heart failure symptoms, ventricular tachyarrhythmias, and thromboembolic events. We report two cases of NVM, one associated with a ventricular septal defect and other associated with bicuspid aortic valve.     

Coronary sinus type atrial septal defect in a child with pulmonary atresia and Ebstein's anomaly.

At birth an infant was found to have an unusual series of abnormalities with a coronary sinus type atrial septal defect complicating pulmonary atresia with an intact ventricular septum and Ebstein''s anomaly. The functionally important anomalies were diagnosed by echocardiography and cardiac catheterisation. The coronary sinus defect and Ebstein''s anomaly were detected only at necropsy. Although only a single case, the features of this heart favour Bull''s revised classification of pulmonary atresia.     

Electrocardiographic patterns of the Brugada syndrome in 2 young patients with pectus excavatum

I hypothesized that thoracic deformity of pectus excavatum may induce the Brugada-type electrocardiogram (ECG) pattern because of the presumed chronic injury to the right ventricle. Thus, I examined the 5 outpatients with pectus excavatum to determine the presence or absence of the ECG pattern of Brugada syndrome. Four of 5 study patients accompanied incomplete right bundle branch block pattern. Among these 4, 2 patients presented with Brugada-type ECG pattern, ie, right bundle branch block pattern and ST-segment elevation in the right precordial ECG leads. Both of them with Brugada-type ECG had no past history of syncope, family history of sudden death, or malignant arrhythmias on the 24-h Holter ECG recording. These observations suggest that clinically benign Brugada-type ECG pattern may appear in some patients with pectus excavatum.     

Congenital heart disease in Down's syndrome.

Eighty cases of Down's syndrome were found among 1504 children with congenital heart disease under the age of 15 years. The most common cardiac anomaly, ventricular septal defect, was found in 49 per cent of the 80 cases studied, while the second most frequently encountered anomaly, common atrioventricular canal, was found in 15%. Haemodynamic investigations of 24 cases of ventricular septal defect showed Eisenmenger's syndrome to be present in 10 cases; this seemed to appear at an earlier age in mongoloid children than in other children with ventricular septal defect. Right-to-left shunt was found in 5 out of 9 cases of common atrioventricular canal. Pulmonary hypertension was found in all of 24 cases of ventricular septal defect and in 7 of 9 cases of common atrioventricular canal. The cumulative survival up to 10 years was 64% for girls and 49% for boys. Death was most commonly the result of pulmonary complications which occurred in 22 out of the 34 patients who died.