Nuss手术与改良Ravitch手术的对比研究

Comparison of Nuss procedure and modi fied ravitch procedure

目的对比研究微创Nuss手术与传统改良Ravitch手术治疗小儿漏斗胸。方法随访3年224例漏斗胸手术,其中Nuss手术148例,改良Ravitch手术76例,将两种术式一般情况、围术期情况、并发症和满意度进行比较。结果224例均顺利完成手术。两组患儿平均年龄无差异,但平均手术时间、术中出血量Nuss组(48.63±12.66)、(6.57±12.69)明显少于Ravitch组(90.99±17.24)、(29.25±15.02),有极显著性差异;术后引流量、下地活动时间、术后平均住院天数Nuss组(10.78±12.78)、(1.27±0.55)、(6.81±0.55)低于Ravitch组(27.83±11.73)、(3.63±0.95)、(9.59±0.72),有显著性差异;仅术后引流时间无显著性差异。并发症Nuss组为10.8%,包括2例气胸、10例皮下气肿、1例支架移位、2例疼痛和1例获得性脊柱侧弯。Ravitch组并发症发生率为3.9%,包括气胸、缝线反应和支架移位各1例。两组并发症均无严重致命性,且预后良好。术后1年内、2年内及取支架后患儿及家长满意度均无显著性差异。结论微创矫正小儿漏斗胸的Nuss手术与改良Ravitch手术相比具有切口小而隐蔽、手术时间短、出血少、活动早、不需游离胸壁肌肉皮瓣,不需肋软骨或胸骨的切除、长期保持胸部伸展性,扩张性、柔韧性和弹性等优点。患者手术时机可由3岁到成人,手术成功的关键是手术适应证的正确选择。广泛对称性的漏斗胸尤其合并扁平胸是Nuss手术的最佳选择。凹陷重的局限型漏斗胸及严重不对称的漏斗胸应首选改良Ravitch手术。随着经验的积累,Nuss手术围术期并发症将有所降低。

Objective To compare the efficacies of Nuss procedure and modified Ravitch procedure in treating pectus excavaturm. Methods 224 cases of funnel chest repairs were followed up for three years. Among them, there were 148 Nuss procedures and 76 modified Ravitch procedures. The conditions before, during and after operation, complications and parents satisfaction scores were cornpared. Results Between the two groups, there was no difference in age. The operative time, blood loss, amount of drainage, time to ambulance and duration of hospitalization were significantly less in Nuss group. There was no significant difference in duration of drainage. In Nuss group, complications occurred in 10. 8%, including 2 pneumothorax, 10 subcutaneous emphysema, 1 bar dislocation, 2 persistent pain and 1 acquired lateral curvature. In Ravitch group complication rate was 3.9%, including pneumothorax, suture reaction and dislocation in lease respectively. There was no fetal complication.In one year, two years after operation and after moving the bar, the contentment had no significant difference between two groups. Conclusions Compared with modified Ravitch group, Nuss procedure is less traumatic.