桥式连接技术在漏斗胸手术中的应用

Application of bridge technique for pectus bar fixation during Nuss procedure

目的总结桥式连接技术在漏斗胸手术中的应用价值。方法回顾性分析首都医科大学附属北京儿童医院胸外科2018年7月至2021年1月收治的25例漏斗胸患儿临床资料,其中男21例,女4例;年龄10岁5个月至16岁9个月(平均年龄14岁4个月);Haller指数3.16~6.78(平均4.93);轻度1例(Haller指数<3.2),中度2例(Haller指数3.2~3.5),重度18例(Haller指数3.5~6),极重度4例(Haller指数﹥6)。患儿均在胸腔镜辅助下行Nuss手术并采用桥式连接技术进行固定,总结并分析所有患儿一般资料、手术效果及并发症情况。结果25例均顺利完成手术,无一例发生术中并发症。术后出现并发症3例,其中双侧胸腔积液1例(1/25,4%),于B超定位下穿刺抽液后缓解;桥式连接片螺母螺钉脱离2例(2/25,8%),均为单侧单个固定片螺母脱落,支架未出现移位,胸壁外观未受影响,脱落螺母于取支架手术时同期取出。取支架后进行手术效果评估,优良率100%,无一例复发。结论桥式连接技术矫治儿童漏斗胸安全有效,可降低钢板移位风险,获得满意矫正效果。

Objective To summarize the experience of bridge technique for pectus excavatum(PE).Methods From July 2018 to January 2021,25 PE children undergoing thoracoscopic Nuss procedure with fixation by bridge technique.There were 21 boys and 4 girls with a mean age of 172(125-201)month.Haller index had a mean value of 4.93(3.16-6.78).Severity was mild(n=1,<3.2),moderate(n=2,3.2-3.5),severe(n=18,3.5-6)and extremely severe(n=4,>6).Results There was one case of short-term postoperative complication.Bilateral pleural effusion was relieved after puncture under B-ultrasonic positioning.Two children(8%)had long-term complication of bridge connector nut and screw detachment.Both were of unilateral single fixator nut loss.Without bar displacement,appearance of chest wall was not affected.Loose nut was removed at the same time as bar removal.There was no recurrence.Conclusion The application of bridge technique for pectus excavatum is safe and effective,which can reduce the risk of bar displacement and achieve satisfactory correction effect.