重度漏斗胸伴先天性肺囊性病变同期手术治疗5例

目的总结重度漏斗胸伴先天性肺囊性病变的同期手术治疗经验。方法回顾性分析本院自2007年开展Nuss术至今所收治的漏斗胸病例资料,分析重度漏斗胸伴先天性肺囊性病变同期手术治疗情况。结果患儿5例,男性3例,女性2例,年龄分别为:4个月、8个月、3岁、1岁9个月、11岁,漏斗胸Hailer指数平均5.12(3.57~7.19),肺囊性病变的病理类型:先天性囊腺瘤样畸形3例,先天性囊腺瘤样畸形并支气管源性囊肿1例,大叶性肺气肿1例。手术方式:先行肺囊性变肺叶切除,再行胸腔镜辅助Nuss术,平均手术时间176(90~300)min,手术失血量80(30~120)mL,术后8.2(3~19)h撤离呼吸机。术后并发症:胸部皮下气肿1例,随访13(1~26)个月,疗效满意。结论重度漏斗胸伴先天性肺囊性病变肺叶切除同期手术治疗方案可行,胸壁畸形矫治近中期效果满意,远期效果有待进一步观察。

One-stage operation for pectus excavatum concomitant congenital cystic lung lesion

Objetive This study aimed to analyze the treatment experience of Nuss procedure combined with simultaneous thoracic procedures. Methods A total of 501 patients,who underwent minimally invasive pectus repair in Nuss technique over 8 years,from 2007 to 2015,were retrospectively analyzed. Results 5 patients (3 male and 2 female;age:4 —months,8 —months,3 —years,1 —years and 9 months,11years)under-went the Nuss procedure with concomitant thoracic lobectomy for congenital cystic lung lesion.The mean Haller index:5.12 (range,3,57 ~7.19).The pathology results showed that:1 case with congenital lobar emphyse-ma,and 4 cases with congenital adenomatoid cystic malformation,one of which combined with bronchogenic cysts.All patients underwent a 1-stage procedure with subsequent simultaneous Nuss procedure.The average operating time was 176mins(90 ~300),the blood loss 80ml (30 ~120),the weaning mechanical ventilation time 8.2h(3 ~19).The post-operative complication was observed in 1 case with subcutaneous emphysema.At follow-up (1 ~26 months),5 patients had excellent cosmetic results and good quality of life confirmed by a questionnaire. Conclusions Thoracic lobectomy and subsequent Nuss procedure can be performed simultane-ously with a satisfactory short and moderate-term effect.One-stage operation helps patients with pectus excava-tum concomitant congenital cystic lung lesion recover.