非对称型漏斗胸微创手术的探讨

Preliminary results of mini-invasive repair for asymmetric pectux excavatum in children

目的探讨非对称型漏斗胸的微创手术方法。方法2003年6月至2004年9月住院手术的6例非对称型漏斗胸患儿,按体表和3DCT形态学测量分为Ⅰ、Ⅱ、Ⅲ度,分别采用Nuss原法、斜板及不规则型支撑板方法手术,均采用双3点法固定。结果6例患儿全部在胸腔镜辅助下手术,手术时间65～105min,出血量极少,均不需输血。1例患儿术后轻度胸腔积气,第6天完全吸收。随访2～6个月支撑板的位置良好,胸廓饱满、左右对称,矫正效果满意。结论采用新分类和改良技术,非对称型漏斗胸微创手术矫正短期效果满意,长期效果有待观察。

Objective Minimally invasive repair of pectus excavatum(PE), the Nuss procedure has been limited to children with symmetrical PE. Here we report a newly created morphologic classification and technical modification of Nuss procedure to repair asymmetric PE. Methods All patients with asymmetric PE were classified into typeⅠ,Ⅱ, and Ⅲ, based on chest appearance and 3-D CT configuration. Each type was dealt with the originally Nuss procedure, oblique bar, or irregular shape bar, respectively. Double 3-point bar fixation was used in every case. Results Six patients (4 boys) with Haller CT index of 4.2～6 underwent repair of asymmetric PE. Each type included 2 patients. Operation time was 65～105 mins with little volume of bleeding and without blood transfusion. One girl suffered pneumothorax, but it was completely absorbed on the 6 day after the operation. 2～6 months follow-up reviewed well bar position, and a full, symmetric chest in all patients. Conclusion New classification and technical modifications of Nuss procedure can be utilized to correct asymmetric PE with satisfactory short-term results.