胸腔镜辅助改良Nuss手术治疗49例小儿漏斗胸临床分析

Modified Nuss procedure with thoracoscope for repairing pectus excavatum in children：a re- port of 49 cases

目的总结胸腔镜辅助改良Nuss手术矫治小儿漏斗胸的治疗经验。方法采用胸腔镜辅助改良Nuss手术矫治49例漏斗胸患者，年龄3～18岁，平均年龄（8．9±4．6）岁。36例畸形为对称型，13例为非对称型。结果49例患者手术过程顺利，除1例应用2根支撑钢板外，其余48例均只用1根支撑钢板。术中未发生心脏穿通伤等重大并发症，1例早期并发气胸，平均出血量少于10Tnl。术后住院时间6～8d，所有患者均未输血，胸廓畸形矫正满意。矫形效果43例为优，6例为良。全部患者随访时间0．5～23．0个月，钢板无移位，1例术后间歇疼痛2个月，1例术后23个月取出钢板矫形保持优良。结论改良Nuss手术操作简捷，创伤小，胸廓塑形满意。胸腔镜辅助监视可提高手术的安全性。

Objective To summarize the experience of modified Nuss procedure with thoracoscope for the correction of pectus excavatum in children. Methods Forty-nine pediatric pectus excavatum were treated by modified Nuss procedure with thoracoscope from August 2006 to July 2008, the age ranged from 3 to 18 years, 36 patients were symmetric pectus excavatum and 13 patients were asymmetric pectus excavatum. Results The operations in all patients were successful. Only 1 case used two bars,other 48 cases used one bar. There were no major complications such as cardiac perforation occurred during the operation. The earlier complication was pneumatothorax in 1 case, and the average blood loss was less than 10 ml. The postoperative hospital length of stay was 6-8 days . All patients had a satisfied deformity correction and no needs of transfusion. Therapeutic results evaluation showed excellent in 43 patients and good in 6 patients. All patients were followed up in 0.5-23.0 months without bars displacement, 1 case had chronic intermittent pain for 2 months. The bar had been removed in 1 case after operation 23 months who still kept in excellent result. Conclusions Modified Nuss procedure is easy to performed with minimal invasion and satisfied deformity correction. Thoracoscopic visualization facilitates the safety of this technique.