微创胸骨沉降术矫治鸡胸

摘要：目的探讨微创胸骨沉降术矫治鸡胸的手术适应证、手术方法、安全性和效果。方法回顾性分析2009年7月至2012年8月上海交通大学医学院新华医院40例鸡胸患者行微创胸骨沉降矫治术的临床资料,其中男39例,女1例;平均年龄14．5（12～22）岁;均为初次手术矫治。所有患者前胸明显向前突出,其中21例患者胸骨呈对称性突出,19例呈不对称性突出。术前检查包括心电图、胸部CT、超声心动图、肺功能,Hailer指数为1．91±0．23,其中16例患者存在轻度限制性通气障碍。所有患者均采用Nuss矫形钢板行微创胸骨沉降术,术后3个月限制剧烈活动,2年后取出矫形钢板。结果所有患者均顺利完成手术,术后胸廓外形明显改善,患者和家属对矫正效果均非常满意。手术时间65～115（82．0±15．6）min,平均出血量〈10ml,术后住院时间3～5（3．5±0．8）d．术后Hailer指数为2．39±0．17,较术前显著增加（P〈0．01）。术后并发症包括伤口感染2例,气胸1例（胸腔闭式引流后好转）,皮下积液3例,2例持续疼痛〉14d,围术期未发生严重并发症。40例患者术后随访3～36个月,1例患者因伤口感染提前拆除固定钢板,其余39例患者矫形钢板的位置良好,无钢板移位,无固定片滑脱。其中8例患者已经拆除内固定钢板,未出现鸡胸复发。结论胸廓顺应性较好的青少年鸡胸患者是微创胸骨沉降术的最佳适应证,采用微创胸骨沉降术矫治鸡胸操作简单、安全可靠、创伤小、外形美观,矫形效果满意。

Minimally Invasive Sternal Lowering Operation for the Correction of Pectus Carinatum

Objective To investigate surgical indications, techniques, safety and clinical outcomes of minimally invasive sternal lowering operation for the treatment of pectus earinatum （PC）. Methods Clinical data of 40 PC patients who underwent minimal invasive sternal lowering operation in Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University from July 2009 to August 2012 were retrospectively analyzed. There were 39 male patients and 1 female patient with their average age of 14.5 （ 12-22 ）years. All the patients underwent their surgical correction for the first time, and their chest deformity were characterized by a significant protrusion of the sternum and ribs including 21 symmetric and 19 asym- metric protrusions. Preoperative evaluation included electrocardiogram, CT scan of the chest, echocardiogram and pulmonary function test. Preoperative mean Hailer.index was 1.91 ＋0.23. Sixteen patients had mild restrictive ventilatory disorder. All the patients received minimally invasive sternal lowering operation with a curved Nuss steel bar. Aggravating activities were restricted within 3 months postoperatively, and the steel bar was removed 2 years later. Results All the operations were completed successfully, and thoracic appearance was significantly improved after correction. All the patients and their relatives were very satisfied with the corrective outcomes. The operation time was 65-115 （ 82.0 ＋ 15.6 ） minutes and average intraop- erative blood loss was less than 10 ml. Postoperative hospital stay was 3-5 （3.5 ＋ 0.8 ）days. Postoperative Haller index was 2.39 ＋ 0.17, which was significantly higher than preoperative Haller index （P 〈 0.01 ）. Postoperative complications included wound infection in 2 patients, pneumothorax in 1 patient （cured by closed thoracostomy）, subcutaneous effusion in 3 patients, and persistent pain （longer than 14 days） in 2 patients. There was no other serious postoperative complication. All the 40patients were followed up for 3-36 months after discharge. A steel bars was removed ahead of schedule because of wound infection in one patient. Other steel bars were in normal position in 39 patients and there was no displacement of the steel bars or the stabilizers. Eight patients received removal of the steel bars without PC recurrence. Conclusion Juveniles with PC who have good chest wall compliance are the best candidates for minimally invasive sternal lowering operation which is an easy, safe, reliable, minimally invasive and esthetic procedure with satisfactory corrective outcomes.