电视胸腔镜在小儿漏斗胸治疗中的应用

Video-assisted thoracoscopy in the management of pectus excavatum in children

目的探讨胸腔镜在胸骨后钢板置入胸骨抬举法(Nuss技术)治疗小儿漏斗胸的价值.方法胸腔镜直视下Nuss技术治疗45例漏斗胸.术前,将特制钢板按胸廓自然弧度弯成'弓'状,亚甲蓝标记切口及凹陷最低点;术中,右胸腔置入电视胸腔镜,直视下将'弓'形支架引入胸骨下,缝合固定.结果45例支架安全置入,手术时间35～80 min,平均60min.术中出血量＜5 ml.术后住院4～10 d,平均7 d.40例随访3～30个月,平均16.5月.早期并发症2例,分别为气胸和肺炎.远期并发症3例,1例1年后因支架移位重新固定,2例术后胸骨持续疼痛,经口服及局部涂抹解热镇痛药,1年后症状消失.10例术后满2年取出钢板,胸廓塑形好.结论胸腔镜直视下Nuss技术治疗小儿漏斗胸安全可靠,手术时间短,操作简单,矫形满意,术中、术后并发症少,值得推广.

Objective To discuss the value of video - assisted thoracoscopic repair in the treatment of pectus excavatum in children. Methods Thoracoscopic sternum elevation with an internal steel bar （ Nuss procedure） was performed in 45 children with pectus excavatum. Preoperatively, a curved steel bar was prepared and the site of incision and the lowest part of the depression were labeled with methylene blue. Under right - sided thoracoscopic vision, the bar was inserted into the retrosternal tunnel thereby correcting deformity. Results The steel bar was placed safely in all the 45 patients. The operation time was 35 - 80 min （ mean, 60 min）. The intraoperative blood loss was less than 5 ml. The length of postoperative hospital stay was 4 - 10 days （mean, 7 days）. Forty children were followed for 3 - 30 months （ mean, 16.5 months）. Short - term complieations included pneumothorax in 1 patient and pneumonia in 1 patient. Long - term complications included bar shift after 1 year in 1 patient and persistent sternal pain in 2 patients （which had been cured by oral and local analgetic administration）. The bar had been removed in 10 children, all of whom had good cosmetic results. Conclusions Video - assisted thoracoscopic Nuss procedure is safe and effective in the management of pectus excavatum in children, with advantages of short operation time, simple performance, satisfactory cosmetic results, and fewer complications.