两切口Nuss手术与传统Nuss手术的对比研究

Two-incision Modified Nuss vs Traditional Nuss:Case Control Study

目的探讨两切口Nuss手术治疗漏斗胸的安全性和可行性。方法回顾对比分析2005年10月～2007年10月103例传统三切口Nuss手术(Nuss组),与105例改良两切口Nuss手术(Nuss改良组)的临床资料,比较2种术式围手术期情况、并发症和手术效果。结果208例均顺利完成手术,Nuss改良组手术优占94.3%与Nuss组88.3%无统计学差异(x^2=2.318,P=0.128)。Nuss改良组患者的手术时间(39.2±7.4)min、术后住院时间(6.3±0.7)d均显著短于Nuss组(45.4±9.2)min、(7.2±0.9)d(t=5.361,P=0.000;t=8.059,P=0.000)。Nuss改良组患者术中出血量中位数为2.8 mI,显著少于Nuss组3.0 ml(x^2=5.158,P=0.000)。2组发生并发症各5例(Nuss组:1例气胸、1例血胸、1例心包穿孔和2例膈肌及肝脏损伤;Nuss改良组:气胸4例、心包穿孔1例),无统计学差异(x^2=0.001,P=0.975)。随访3～30个月,无复发及远期并发症。结论改良两切口Nuss手术不但减少了一个切口,其手术时间、术中出血量和术后住院时间明显优于传统三切口Nuss手术;而且更容易观察到对侧的情况,安全和可行。

Objective To compare the safety and feasibility of two-incision modified and traditional Nuss procedures for children with pectus excavatum. Methods From October 2005 to October 2007, totally 208 cases of pectus excavatum received Nuss surgeries, including three-incision traditional Nuss in 103 cases and two-incision modified Nuss in 105 cases, in our hospital. The perioperative records, complications and the surgical outcomes of the two groups were compared. Results The procedures were completed in all of the 208 patients. The rate of good outcomes in the two groups were similar （94.3% vs. 88.3% , X^2 = 2. 318 ,P = 0. 128）. Whereas, the operation time and hospital stay of the modified group was significantly shorter than those in the traditional group [（39.2±7.4） min and （6.3±0.7） d vs （45.4 ±9.2） min and （7.2 ±0.9） d;t=5.361, P=0.000 and t=8.059, P=0.000]. Furthermore, the modified group had significantly less intraoperative blood loss （median, 2.8 ml） than the other group （X^2 = 5. 158, P =0. 000）. No significant difference was found in the rage of postoperative complications between the two groups （Traditional group： pneumothorax in 1 , haemothorax in 1 , pericardial perforation in 1 , and injuries to the diaphragm or liver in 2; Modified group： pneumothorax in 4, and pericardial perforation in 1; X^2 = 0. 001, P = 0. 975）. The patients were followed up for 3 to 30 months, during which none of them had recurrence or long-term complications. Conclusions Two-incision modified Nuss procedure is not only less traumatic, but also results in shorter operation time and hospital stay, and less blood loss, than the traditional procedure. In addition, as the contralateral structures are visible during the operation, the modified method is simmore ple and safer.