胸腔镜辅助漏斗胸Nuss矫正术的技术改进

Thoracoscopy-assisted Nuss procedure and its modification for repair of Pectus excavatum

目的: 探讨施行胸腔镜辅助漏斗胸Nuss矫正术的改进结果和并发症的预防方法.方法: 参照Nuss所报告的原理,经左侧胸腔镜指导,心电图监测及抬高胸骨下端后穿通胸骨后隧道,进行双三点支撑板固定.回顾总结26例手术与随访结果.结果: 除2例有伴发畸形者外,24例手术时间40～95(平均52) min;术中出血少于15 mL,术后平均住院6 d.伴支气管源肺囊肿及肺叶肺气肿1例先行胸腔镜右肺上叶切除,再行漏斗胸矫正.早期并发症胸腔残留气体3例,少量胸腔积液1例,均自动吸收.切口红肿1例(未感染).随访 3～35 mo.术前反复感染患儿症状改善最明显.支撑板位置优15例,良4例.5例已取出支撑板,矫正效果优4例,良1例.结论: 胸腔镜辅助漏斗胸Nuss矫正术创伤小、出血少、恢复快,手术年龄以4～8岁为宜,对称性漏斗胸短期矫正效果可靠.推荐左侧胸腔进镜,术中心电图监测和牵高胸骨,双三点固定支撑板.

AIM: To review the results of Pectus excavatum (PE) repaired by the modified Nuss procedure and the measures for prevention of complications.METHODS: A retrospective review was conducted in 26 patients who had undergone repair of PE by the thoracoscopy-assisted modified Nuss procedures from October 2001 to June 2004.Our technical modification included left-sided thoracoscopy,ECG monitoring,elevation of the sternum during the pectus clamp passage and a double 3-point bar fixation.RESULTS: Except for two patients with associated anomalies,the other 24 patients had a mean operation time of 52 (40~95) minutes with a less than 15 mL bleeding and a mean postoperative stay of 6 days.Early complications including pneumothorax was found in 3 cases and pleural infusion in one,and they all resolved spontaneously.One patient had a wound seroma without infection.All patients were followed up from 3 to 35 months.Marked improvement was observed in patients who had recurrent respiratory infection before surgery.The position of the bar,as displayed by lateral chest X-ray,was excellent in 15 cases and good in 4.Of the 5 cases who had the bar removed,4 had excellent result and 1 had good result as evaluated by Croitoru's criteria.CONCLUSION: Thoracoscopy-assisted Nuss repair is an alternative repair for the symmetric PE with remarkable technical simplicity,mini-invasiveness,rapid recovery and cosmetic advantage.The best age for this procedure should be 4~8 years.The author recommends a left-sided thoracoscopy,ECG monitoring and elevation of the sternum during the pectus clamp passage and a double 3-point bar fixation.