带上下血管蒂的改良胸骨翻转术治疗漏斗胸22例

Modified sterno - turnover operation with up - down blood vessel pedicles in trea- ting 22 cases of pectus excavatum

目的总结带上下血管蒂的改良胸骨翻转术治疗漏斗胸22例的经验。方法1998年2月至2008年5月手术治疗漏斗胸22例，均为男性，年龄4～20岁，漏斗胸指数均大于0．2。全组均采用保留双侧胸廓内动脉和带腹壁上动脉的腹直肌蒂的胸骨180。翻转方式，翻转后两侧胸廓内动脉及两侧带腹壁上动脉的腹直肌均呈十字交叉状置于胸骨前。结果全组病例术后胸骨凹陷均得到完全纠正，胸廓外形满意，术后无一例发生胸骨缺血坏死，切口均Ⅰ期愈合。术中胸膜破裂16例（73％），术后并发症主要为胸腔积液2例（9．1％），均痊愈出院。术后住院10—15d（平均12d），随访3个月～4年，未见复发。结论带上下血管蒂的改良胸骨翻转术治疗漏斗胸近远期效果满意。

Objective To summarize the experience of the modified sterno - turnover with up - down blood vessel pedicles in treating 22 cases of pectus excavatum. Methods Twenty - two male patients aged from 4 to 20 years with pectus excavatum were operated from Feb. 1998 to May 2008. All of the funnel indexed were higher than 0.2. The double internal mammary arteries and superior epigastric arteries were both reserved and the sternum was turned over for 180°. After that, both the double internal mammary arteries and the superior epigastric arteries were placed across in front of the sternum. Results All the deformities of the sunken sternum were totally corrected and patients attained good appearance. No necrosis was found in this group and the incisions healed by first intention. Pleura cavity was broken in 16 cases （73%）. Main complication of operation was pleural effusion in 2 cases （9.1%）, and both patients recovered and were discharged later. The hospital stay after operation was 10 to 15 days （mean 12 days） , and during the follow - up period from 3 months to 4 years no palindromia was found. Conclusion The modified sterno - turnover operation for pectus excavatum can obtain short - and long - term satisfactory effect.