胸膜外入路与胸膜腔入路Nuss手术对照研究

Comparison of Thoracoscopic Extrapleural and Intrapleural Nuss Procedures for Pectus Excavatum in Children

目的对胸膜外入路与胸膜腔入路钢板植入胸骨抬举术(Nuss手术)治疗小儿漏斗胸的效果进行比较。方法2006年7月～2007年11月28例漏斗胸患儿按手术时间分为胸膜外入路组(n=12)和胸膜腔入路组(n=16),比较2组手术情况和疗效。结果2组均顺利完成手术,术中未发生气胸,无心包、心脏、肺损伤,手术结束漏斗畸形即校正。2组手术时间(34.4±3.4)min vs(33.4±5.9)min无统计学差异(t=0.524,P=0.605)。胸膜外入路组术中出血量(2.5±0.5) ml显著少于胸膜腔入路组(7.5±2.6)ml(t=-6.542,P=0.000),但最大出血量仅有10 ml。胸膜外入路组住院时间(3.8±1.2)d显著短于胸膜腔入路组(5.6±1.8)d(t=-2.994,P=0.006)。胸膜外入路组满意率为100%与胸膜腔入路组93.8%无统计学差异(P=1.000)。胸膜外入路组皮下气肿、胸膜刺激征发生率显著低于胸膜腔入路组(0 vs 31.2%,P= 0.053;0 vs 31.2%,P=0.053)。28例患儿随访2～10个月,平均7.6月,所有患儿胸廓外形维持优良,无钢板及固定器移位、滑动或旋转,无肺感染。结论胸膜外入路与胸膜腔入路钢板植入胸骨抬举术治疗小儿漏斗胸安全、可行、有效。胸膜外入路与胸膜腔入路Nuss手术比较具有并发症少、恢复快、胸膜腔完整等优点。

Objective To compare the efficacies of extrapleural and intraplerral Nuss procedures for pectus excavatum in children. Methods From July 2006 to November 2007, 28 children with pectus excavatum were treated with extrapleural （ 12 cases） or intraplerral （16 cases） Nuss procedures. The outcomes of the two groups were compared. Results The operation was completed successfully in all the 28 cases. None of the children developed pneumothorax or injuries to the pericardium, heart, or lungs. The pectus excavatum was cured immediately after the operations in all the cases. The two groups experienced similar operation time [ （34.4±3.4） min vs （ 33.4±5.9） min, t = 0. 524, P = 0. 605 ] ; however the blood loss in the extrapleural group was significantly less than that in the intrapleural group[ （2. 5 ±0. 5 ） ml vs （7.5 ±2. 6） ml, t = - 6. 542, P = 0. 000 ]. The maximum blood loss was 10 ml in the extrapleural group. Compared to the intrapleural group, the extrapleural group had significantly shorter postoperative hospital stay[ （3.8 ± 1.2） d vs （5.6 ±1.8） d, t = -2. 994, P =0. 006] , but similar rate of good outcomes （ 100% vs 93.8% , P = 1. 000）. No patients in the extrapleural group developed emphysema or pleural irritation, while 31.2% of the patients in intrapleural group showed the symptoms （P = 0. 053）. The two groups were followed up for 2 to 10 months（ mean,7.6 months）; during the period, none of the children had pulmonary infection or dislocation of the steel board or fixation instruments. All of the patients achieved good cosmetic outcomes. Conclusions Both extrapleural and intraplerral Nuss procedures are effective and safe for pectus excavatum in children. The extrapleural approach is not only superior in postoperative recovery and pleural cavity protection, but also results in less complications than the intrapleural procedures.