胸腔镜下Nuss手术治疗小儿漏斗胸38例报告

Thoracoscopic Nuss procedure for the correction of pectus excavatum in 38 children

目的探讨胸腔镜下Nuss手术治疗小儿漏斗胸的疗效和安全性。方法胸腔镜监视下用穿通器在胸骨凹陷最低点水平，两腋中线之间，于胸膜外经胸骨后穿通一遂道，放置支撑板将凹陷胸骨抬起，支撑板两端安装固定器。5例使用进口器械，33例使用国产器械。结果38例均在胸腔镜辅助下顺利完成手术，手术时间40～80min，平均50min。术中出血量5～30ml，平均16ml。36例放置1根钢板支撑，2例放置2根钢板支撑。术后气胸4例，皮下气肿16例，右侧固定器滑脱1例，钢板轻度翻转1例。术后住院7～21d，平均8d。38例随访3～22个月，平均11个月，优36例，良2例，优良率100％。结论胸腔镜辅助下Nuss手术治疗小儿漏斗胸方法安全可靠，疗效好，手术最佳时机3～12岁。

Objective To assess the efficacy and safety of the Nuss procedure in the treatment of pectus excavatum in children. Methods The Nuss procedure was performed in 38 patients. Under thoracoscopy, a convex steel bar was inserted under the sternum through small bilateral thoracic incisions, with the convexity facing posteriorly. When the bar was in position, it was turned over, thereby correcting the deformity. Two lateral stabilizing bars were employed. Out of the 38 patients, imported bars were used in 5 patients and China-made bars were used in 33 patients. Results The procedure was completed under thoracoscopy smoothly in all the 38 patients. The operating time was 40～80 min （mean, 50 min） and the intraoperative blood loss was 5～30 ml （mean, 16 ml）. A single bar was utilized in 36 patients, and a second bar was required in 2. Complications included postoperative pneumothorax in 4 patients, subcutaneous emphysema in 16 patients, bar displacement in 1 patient, and lateral stabilizer dislocation in 1 patient. The length of postoperative hospital stay was 7～21 days （mean, 8 days）. Follow-up checkups in the 38 patients for 3～22 months （mean, 11 months） showed excellent outcomes in 36 cases and good outcomes in 2 patients, the rate of excellent or good results being 100%. Conclusions The Nuss procedure is safe and reliable for the treatment of pectus excavatum in children. The best age range for surgery was 3～12 years old.