使用NUSS微创矫正术治疗漏斗胸4例分析

目的总结使用Nuss微创畸形矫正术治疗漏斗胸的经验。方法于右侧腋中线第8肋间切开皮肤2cm，用胸腔镜观察患者胸骨后无异常血管后，延漏斗胸最低点水平面的两侧腋中线处，切开皮肤2cm，皮下潜行游离至漏斗胸边缘，用Nuss导引器自右侧皮肤切口进入经皮下隧道至漏斗边缘，穿通胸腔，在胸腔镜监视下至左侧漏斗胸边对应点穿出胸腔，经左侧皮下皮肤切口穿出，10^#丝线一头打结连于导引器，另一头打结连于事先塑性好的Nuss棒，缓慢退出导引器，将Nuss棒带人胸腔，并使其两头置于分离的潜行的切口皮下，再用Nuss翻转器接右侧的Nuss棒头，旋转180°，即刻漏斗胸被顶起，右侧Nuss棒头装上Nuss固定器缝合固定于胸壁肌肉。缝合两侧的皮肤切口。胸腔镜探视口置胸腔闭式引流管。结果近期结果：患者术后恢复良好，24～72h拔除胸腔引流管，第4～5天出院，除1例患者出现术中心包破裂外（未损伤心脏大血管），未出现其它术中术后并发症；远期结果：已随访1～10月，患者均正常生活，无特殊不适主诉。复查X片，Nuss棒条未见移位。结论Nuss微创畸形矫正术和传统的漏斗胸手术相比，具有安全易操作，微创美观之优点，长期疗效有待进一步观察。

Analysis of minimally invasive repair of pectus excavatum through Nuss procedure in 4 patients

Aim To evaluate the experience of repair of peetus exeavatum through Nuss procedure. Methods After the skin of the cross of right linea medio-axillaris and the 8th intercostal was opened 2 cm long, thoraeoseope was put into thoracic cavity and there was not any abnormal blood vessel to be found. Then the skins of the cross of right and left linea medio-axillaris and the lowest point of plane of peetus exeavatum were also opened 2cm long, subcutaneous tissue was dissociated to edge of peetus exeavatum bluntly. Then Nuss guide passed through from the right opening of skin, two side subcutaneous tunnel, the lowest point of peetus exeavatu in thorax, to the left one. The Nuss guide must bore a hole into thorax at right subcutaneous edge of peetus exeavatum and come out from the left one. Then the Nuss guide was linked with the 10th silk thread at one end and the Nuss support bar was also linked with the 10th silk thread at another end, Backing forward the Nuss guide,the Nuss support bar was taken into the thorax and was revolved at 180°subsequently. The peetus exeavatum was supported immediately. The right point of the Nuss support bar was installed with the Nuss stabilizer and sawn with thoracic muscle. Then the openings of skin were sawn and the closed drainage of pleural cavity was finished through the observing hole of thoraeo- scope. Results The results of short term ： all the 4 patients recover very well postoperation. Their pipe of dosed thoracic drainage was taken away during 24 - 72 h and they were permitted to be discharged from hospital after 4 - 5 days. Except 1 patient who had rupture of the pericardium, the others did not have any other complications. The results of long term：by means of follow-up 1 - 10 months, all 4 patients live normally and they do not have any diseonafort. The Nuss support bar have not been moved through X-ray. Conclusion In eomparasion with traditional operation,Nuss procedure not only is safe and minimally invasive but also can be easily mastered by surgeon. Its long term cu