NUSS手术治疗小儿漏斗胸的临床效果观察

目的探讨Nuss手术治疗小儿漏斗胸的临床效果。方法采用Nuss手术治疗小儿漏斗胸87例,男62例,女25例,平均年龄5.8岁(3～21岁),3～6岁43例,7～10岁28例,11～16岁9例,17～21岁7例。在胸腔镜监视下,先用弯钳在胸骨凹陷最低点切开胸膜,钝性分离胸膜外胸骨后隧道(避免在导入引导器时损伤心包);于胸骨凹陷最低点右侧肋间最高点穿入引导器至右侧胸腔,经分离的隧道紧贴胸骨至胸骨左侧,于左侧对应的最高点肋间穿出引导器;将矫形钢板凹面朝上导入,翻转180°顶起胸骨;两侧安装固定片,以2-0可吸收缝线将固定片与肋骨膜缝合;缝合肌肉和皮肤,不留胸腔引流管。手术后2年常规取出钢板。结果87例均顺利完成手术,无中转开放手术者,平均手术时间37.6min(24～120min),出血量2～10ml,手术后平均住院时间5.9d(2～9d)。无心包损伤发生。全部病例平均随访29.6个月(3～60个月),疗效满意78例(91.9%),获得改善5例(5.7%),不满意4例,差4例。年龄越小,满意度越高,3～6岁和7～10岁组满意度分别为97.6%、96.4%,而17～21岁组满意度为28.6%,二者差异有显著统计学意义(P<0.01);11～16岁组满意度为77.7%,比17～21岁明显增高(P<0.01),与3～6岁和7～10岁组比较无统计学意义(P>0.05)。结论Nuss手术矫治小儿先天性漏斗胸安全有效,具有损伤小,恢复快,兼顾美容的优点,年龄越小,效果越好。

The observation of clini cai effects of Nuss procedure for the correction of pectus excavatum in children

Objective To discuss the clinical effects of Nuss procedure for the correction of pectus excavatum in children. Methods 87 children (62 male and 25 female,aged from 3 years to 21 years,mean 5.8 years) with pectus excavatum underwent Nuss procedure,among all the children,43 were younger than 6 years,28 were ranged from 7 years to 10 years,9 were ranged from 11 years to 16 years and 7 were older than 17 years. Under thoracoscopy,a convex steel bar was inserted under the sternum through small bilateral thoracic incisions,with the concavity facing upward. When the steel bar was in position,it was turned over and therefore correcting the deformity and then two lateral stabilizing bars were used. The muscle and skin were sutured and the chest was closed without the intrathoracic drain tube. And the steel bar was removed 2 years later. Results The operation was completed under thoracoscopy uneventfully and no need for open the chest. The operation time was ranged from 24 minutes to 120 minutes,mean 37.6 minutes with the bleeding 2 to 10 ml. After the procedure,the hospitalization time was ranged from 2 days to 9 days,mean 5.9 days. All patients were followed-up for 2 months to 60 months,mean 29.6 months and follow-up check showed excellent outcomes in 78 cases (91.9%),good outcomes in 5 cases (5.7%),and bad outcomes in 4 cases (4.6%). Age was an important factor related to the outcome. The younger patients had better outcome. The satisfaction rate was 97.6% in the children whose age ranged from 3 years to 6 years,96.4% in 7-10 years children and 28.6% in 17-21 years old children (P<0.01),which was also low than that in children whose age ranged from 11 years to 16 years (77.7%,P<0.01). The satisfaction rates in children younger than 6-year old and in children aged from 7 years to 10 years were not different significantly (P>0.05). Conclusions The Nuss procedure has the advantages of minimal invasion and rapid recovery and therefore is safe and reliable for the treatment of pectus excavatum in children.