Nuss手术并发症的处理及预防

目的 探讨微创Nuss手术治疗漏斗胸的手术并发症,预防方法及处理原则.方法 2002年7月至2008年7月共行613例Nuss手术,其中55例为复发的漏斗胸,116例为有合并症的漏斗胸.35例出现并发症,占5.71%.分析术中并发症和术后并发症出现的原因,总结处理方法和预防的原则.结果 613例均顺利完成手术,手术时间25～300 min,术中出血1～200 ml.术中并发症10例,包括心包损伤4例、心脏损伤1例、膈肌穿通肝脏损伤2例、肋间肌撕脱2例,肋间血管损伤1例;均在术中得到妥善处理.术后并发症25例,包括支撑架移位3例、液气胸14例、长期疼痛5例(疼痛造成脊柱侧弯3例)、引流管断入胸腔1例、金属排斥和伤口感染各1例;支撑架移位、支撑架排斥和引流管断入胸腔各1例均再手术后痊愈,其余保守治疗治愈.结论 Nuss手术虽然并发症发生率较高但多属于轻微并发症,随着对并发症的认识和技术的进步,并发症的发生率将大大降低.

Treatment and prevention of the complications of Nuss procedure

Objective To discuss the prevention and the treatment of the complications of minimally invasive operation (Nuss procedure) for funnel chest.Methods Six hundred and thirteen children with funnel chest were treated by Nuss procedure from July 2002 to July 2008.Among them,55 patients were recurrent cases and 116 patients had other diseases.35 cases (5.71%) developed perioperative complications.Results Nuss procedure was completed in 613 patients.The operating times ranged from 25 to 300 minutes.The intraoperative blood loss was 1-200 ml.The intraoperative complications were developed in 10 cases (28.57%),including pericardium injury in 4 cases,heart injury in 1,liver injury by diaphragm penetrating in 2,intercostal muscle avulsion in 2,and intercostal vascular injury in 1.All of the intraoperative complications were found during the operations and had been dealed properlyThe postoperative complications were occurred in 25 cases (71.43%),including brackets shift in 3 cases,liquid pneumothorax in 4,and long-term chest pain in 5.The case of brackets shift,metal exclusion and drainage tube breaking,which are mentioned above,had recovered after surgery,and the others had been cured by conservative treatment.Conclusion Although the incidence of complications is higher but most of them are slight.Along with the understanding of the complications and the progress of technology,the complications could be greatly reduced.The minimally invasive surgery (Nuss procedure) has become the standard surgery of pectus excavatum.