小儿先天性漏斗胸的治疗决策

Decision-making of treatment for pectus excavatum in chideren

目的总结79例小儿先天性漏斗胸的治疗经验。方法2000年9月～2004年12月间手术治疗先天性漏斗胸79例，男64例，女15例，年龄3～12岁，平均年龄4岁。体重15～32kg。有不同程度的反复呼吸道感染病史35例；有活动后气促13例；心电图T波改变或心肌劳损39例；X线胸片显示有不同程度的心脏左移18例。肺功能检查有限制型通气障碍24例；二尖瓣脱垂1例；漏斗胸指数（FI）〉0．3有30例；FI为0．2～0．3有47例；FI〈0.2有2例；Heller指数（CT）〉3．2有1例。结果全组患儿漏斗胸的矫治均采用改良胸骨上举术方法。早期并发症：肺不张2例，肺部感染1例，胸腔积液2例，伤口感染并形成溃疡1例；晚期并发症：第2、3肋软骨前凸畸形1例。72例术后随访1～5年，复查所见胸廓塑型满意，胸壁强度理想，无反复呼吸道感染，运动后气促消失，生长发育与同龄儿相同，无一复发。全组术后住院7～15天（平均9天）。结论小儿中、重度的先天性漏斗胸应选择手术治疗；手术年龄掌握在年龄3～5岁为宜，改良胸骨上举术近远期效果满意，无严重并发症，可作为首选术式；术中需注意保护肋骨肋软骨的结合部。

Objective To review the experience of surgical repair of pectus excavatum in children. Methods 79 cases with pectus excavatum underwent operation between Sep. 2000 and Dec. 2004. There were 64 male and 15 female. Median age at operation was 4 years （range 2～15）. Range of body weight was 150～32 kg. 35 casese had recurrent upper respiratoryteract infection, 13 cases had a decrease in exercise tolerance. ECG changes were T wave changes or cardiac damage in 39 patients. The heart was deviated into the left thoracic cavity to varying degrees in 18 patients demonstrated by chest radiographs. 24 cases had dysfunction of restrictive ventilation by lung function examination. 1 case had mitral valve prolapse. FI more than 0.3 was found in 30 patients, 0.2 to 0.3 in 47, and less than 0.2 in 2. Hailer CT index greater than 3.2 in 1 patient. Results All of patients underwent the modified sternal elevation procedure. Early complications including 2 casese with atelectasis, 1 case with pneumonia, 1 cases with pleural effusion and 1 case with wound infection. Long-term complications： 1 case with protrusion deformity of the second and/or third costal cartilages. The postoperative follow-up was available in 72 patients ranging from 1 to 5 years. The patients had normal appearance of chest wall and cosmetic results. The cases had no recurrent upper respiratorytract infection, Patients had a increase in exercise intolerance, No recurrence was occurred. The mean postoperative hospital stay was 9 days （range 7～15）. Conclusion Medium and serious pectus excavatum in children need a surgical repair. The Suitable time for operation is at 3～5 years-old. The modified sternal elevation procedure can made a low complication rate and excellent cosmetic results. It should be the first choose for surgical repair of funnel chest in children. It is very importance to avoid damaging the growth center of the costochondral junction during operation.