先天性漏斗胸合并先天性心胸疾病的同期手术治疗

目的：研究先天性漏斗胸(pectus excavatum，PE)合并先天性心胸疾病患儿同期手术治疗的方法及原则。 方法：回顾性分析2007年1月至2018年9月于湖南省儿童医院住院治疗的27例先天性PE合并先天性心胸疾病患儿的资 料，分为PE合并先天性心脏病(congenital heart disease，CHD)组(n=17)及PE合并胸科疾病组(n=10)。PE合并CHD组中， PE接受自制胸骨抬举装置及Nuss手术矫治，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；PE合并胸科疾病组接受同期胸部手术矫治+Nuss手术。结果：27例患儿均接受同期 手术矫治。PE合并CHD组住院时间为8.0~25.0(13.2±4.8) d，2例并发切口延期愈合，1例术后左侧少量胸腔积液；PE合 并胸科疾病组住院时间为10.0~34.0(19.9±7.5) d，1例并发乳糜胸，2例胸腔积液。两组患者心胸疾病及PE矫治均满意， 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：依据病人的特点选择个体化的方案予以同期矫治 儿童PE合并心胸疾病，可避免多次手术和麻醉风险，安全有效，同时可减少家属的经济负担。

Simultaneous surgical treatment for pectus excavatum combined with congenital cardiothoracic diseases

Objective: To study the methods and principles for simultaneous treatment in the children with pectus excavatum (PE) combined with congenital cardiothoracic diseases. Methods: Th e medical records of all children, who underwent simultaneous repair of PE combined with congenital cardiothoracic diseases, were retrospectively reviewed in Hunan Children’s Hospital from January 2007 to September 2018. The patients were divided into a PE combined with congenital heart disease (CHD) group (n=17) and a PE combined with thoracic diseasegroup (n=10). The repair with a custom-made sternal lifting device, a Nuss repair, were performed in the treatment of PE, and the correction of the CHD was performed by heart open surgery using cardiopulmonary bypass (through sternotomy or right infra-axillary thoracotomy) or by transcatheter closure under echocardiography or X-ray-guided percutaneous intervention in the PE combined with CHD group. The children in the PE combined with thoracic disease group underwent thoracic surgery plus Nuss procedure concurrently. Results: All 27 pediatric patients underwent simultaneous repair of the PE combined with congenital cardiothoracic diseases. In the PE combined with CHD group, the duration of hospital stay ranged from 8.0 to 25.0 (13.2±4.8) days. Two patients had delayed healing of the surgical wound and 1 patient developed a small left pleural effusion postoperatively. In the PE combined with thoracic disease group, the duration of hospital stay ranged from 10.0 to 34.0 (19.9±7.5) days. One patient was complicated with chylothorax and 2 patients were complicated with pleural effusionin. The treatment for the patients in the 2 groups was satisfactory. No severe complications like surgical death, severe bleeding, chest organ injuries, and implant rejections were observed. Conclusion: According to the characteristics of patients, individualized programs should be selected in order to correct children's PE combined with congenital cardiothoracic diseases in the same period, which are safe, effective and can avoid the risk of multiple operations and anesthesia, and can reduce the financial burden of family.