胸腔镜下钢板植入胸骨抬举术治疗小儿漏斗胸

Thoracoscopic sternal elevation by a steel bar inserted for the correction of pectus excavatum in children

目的探讨胸腔镜下钢板植入胸骨抬举术（Nuss手术）治疗小儿漏斗胸中的疗效。方法胸腔镜辅助下，经右侧切口用钝剥离器沿胸骨后穿过纵隔至对侧胸壁切口，牵引已塑形好的合金钢板凸面朝后拖过胸骨后方，调整位置后，翻转钢板使凹陷的胸骨和前胸壁抬高。结果11例均顺利完成手术，手术时间50—85min，平均67min；术中出血量5—20ml，平均10ml。优9例，良1例，中1例。8例随访2—15个月，平均6．4月，外观维持良好。结论胸腔镜下Nuss手术治疗小儿漏斗胸创伤小、出血少、操作简便、恢复快、效果满意，值得推广。

Objective To investigate effects of thoracoscopic sternal elevation by using a steel bar （Nuss procedure） in the treatment of pectus excavatum in children. Methods Under the assistance of thoracoscopy, a substernal tunnel was created using a blunt dissector via a right thoracic incision. Then a steel bar was inserted under the sternum. After the bar was placed in position, it was turned over to elevate the deformed sternum and the anterior chest wall. Results The operation was completed successfully in all the 11 cases. The operating time ranged 50 - 85 min （mean, 67 min）. The intraoperative blood loss ranged 5 - 20 ml （mean, 10 ml）. The surgical outcomes were classified as ＂excellent＂ in 9 cases, ＂good＂ in 1 case, and ＂fair＂ in 1. Follow-up observations for 2 - 15 months （ mean, 6.4 months） in 8 cases showed satisfactory appearance. Conclusions Thoracoscopic Nuss procedure for pectus excavatum in children is a minimally invasive technique with limited surgical trauma, minimal blood loss, simple performance, rapid recovery, and good cosmetic results, being worthy of recommendation.