微创漏斗胸矫形术治疗漏斗胸53例报告

Minimally invasive repaire of pectus excavatum: A report of 53 cases

目的探讨微创漏斗胸矫形术（minimally invasive repair of pectus excavatum或Nuss手术）的近期效果。方法53例均在气管插管全麻下手术。双侧胸壁做横行切口，在胸腔镜下将塑形之矫形板由右胸腔经胸骨后穿至左胸腔，翻转矫形板，将胸骨抬起矫正胸骨凹陷，矫形板两侧用固定片固定于肋骨。矫形板放置2年后取出。结果53例均顺利完成手术，手术时间30-240min，平均47min，无术中并发症。术后住院2～14d，平均6．1d。术后疼痛超过1周1例；气胸7例；皮下气肿11例；矫形板旋转3例；单侧固定片滑脱4例；切口感染3例，其中2例被迫将矫形板取出，1例经清创换药伤口愈合。53例随访3-28个月，平均15．6月，优42例，良4例，一般3例，差4例。结论Nuss手术治疗小儿漏斗胸近期效果满意。

Objective To investigate the short - term effects of minimally invasive repair of peetus excavatum （ Nuss procedure）. Methods All the operations were performed under general anesthesia with endotracheal intubation. A transeverse incision was made in each lateral chest wall. A steel bar was passed under the sternum from the right thoracic cavity under thoracoscope. Then the bar was turned over to raise the sternum to the normal position. The bar was fixed with bilateral costal bones by using two stabilizing bars. The bar was removed 2 years after the procedure. Results The operation was successfully accomplished without intraoperative complications in all the 53 cases. The operating time ranged 30 ~ 240 min （mean, 47 rain） and the postoperative hospital stay ranged 2 - 14 days （mean, 6. 1 days）. There were 1 case of postoperative pain for 〉 1 week, 7 cases of pneumothorax, 11 cases of subcutaneous emphysema, 3 cases of bar rotation, and 4 cases of unilateral stabilizing bar displacement. Incisional infection was found in 3 cases, 2 of which received a removal of the bar and 1 of which was cured with debridement and dressing changes. During a follow - up evaluation for 3 - 28 months, the outcomes were calssified as excellent in 42 cases, good in 4 cases, fair in 3 cases, and poor in 4 cases. Conclusions The Nuss procedure is safe and effective for the correction of pecrus excavatum in children.