胸腔镜辅助下成人漏斗胸的Nuss微创矫治术

Thoracoscopy assisted Nuss procedure for pectus excavatum correction in adult

目的探讨成人漏斗胸病人在胸腔镜辅助下行Nuss手术治疗的可行性。方法46例成人漏斗胸病人，年龄16～43岁，平均19.1岁。Haller指数3．27～29．00；其中重度到极重度者36例；不对称者18例；传统术式术后复发者3例。结果全组手术均成功，平均手术时间84min，平均手术失血量为35ml，无严重手术并发症；39例置入1枚钢板，7例严重且广泛凹陷者置入2～3枚钢板；对于不对称性者通过调整钢板固定点、形状和局部截骨等方法加以矫治后亦使胸廓畸形得到较好的矫正。结论胸腔镜辅助下Nuss手术矫治成人漏斗胸同样方便、快捷、安全可靠、疗效满意。

Objective To evaluate the short-term effect and experience of Nuss procedure on 46 adult patients with pectus excavatum. Methods Thoracoscopy assisted Nuss procedure with different ways of anesthesia were applied to 46 cases of adult patients with pectus excavatum, including 3 cases of recurrence after traditional surgical procedure. The patients＇ age ranged from 16 to 43 （mean, 19.1） years and Hailer index was from 3.27 to 29.00. Asymmetric pectus excavatum was found in 18 patients. Results The operation was successfully accomplished without severe complications in all cases. The mean operative time was 84 minutes and the mean volume of blood loss was 35ml. Thirty-nine patients had one bar inserted while the other 7 cases with more extremely diffuse depression required 2 or even 3 bars. Such methods as modifications to the fixing points and the shape of the bar, partial osteotomy, were developed to deal with asymmetric ones. Conclusion To adult patients, thoracoscope assisted Nuss procedure also is a minimally invasive and safety technique for correction of pectus excavatum. It can lead to a satisfactory outcome and surgical time is less.