Nuss手术治疗小儿漏斗胸118例

Nuss procedure for pectus excavatum in 118 pediatric patients

目的总结Nuss手术治疗小儿漏斗胸的临床经验。方法2006年9月～2009年4月，采用Nuss手术治疗118例漏斗胸患儿，其中男89例，女29例；年龄3～16岁，平均（6．4±3．5）岁。3例合并肺部病变患儿经单侧胸部切口完成肺部手术后，直视下安放Nuss钢板，6例复发病例采用胸腔镜辅助完成，其余病例在非胸腔镜下完成。结果118例患儿均顺利完成手术，术中无死亡、大出血及胸腔脏器损伤等严重并发症发生。术后切IZI均I期愈合。除3例合并肺部病变和1例行部分肋骨截骨患儿外，术中平均失血量〈10ml。术后14例出现少量气胸及皮下气肿，经穿刺抽气后消失，1例严重气胸经安置胸腔闭式引流后好转。所有患儿均获得随访，术后1个月及3个月复查均无钢板旋转移位，无固定片滑脱，无胸腔积液，无切口感染。矫形效果98例“优秀”，20例“良好”。结论Nuss手术通过植入特制钢板使胸廓重新塑形，操作简单、微创、损伤小并具有良好的早、中期效果但Nuss手术对漏斗胸患儿肺功能的影响、最佳手术年龄以及远期效果的评价，还需要进一步探讨。

Objective To review the clinical outcome of Nuss procedure for pectus excavatum in children. Methods From September 2006 to April 2009, one hundred and eighteen children （29 females and 89 males） aged 3-16 years （mean 6. 4 3. 52 years） suffering from pectus excavatum underwent Nuss procedure. One hundred and twelve of the cases were corrected without the assistance of thoracoseopie surgery. Three patients had additional lung cyst and underwent open surgery and the other 6 recurrence cases underwent video-assisted thoracoscopic surgery. Results All surgery were successful, with the operative time ranging from 28 to 65 minutes, intraoperative blood loss was less than 10ml and hospital stay averaged 6. 5 days. Postoperative evaluation was ＂excellent＂ in 98 and ＂good＂ in 20 cases. All patients were followed up for 1 20 months without any obvious complaints, except for 14 patient who suffered from pneumothorax and subcutaneous emphysema, which were managed with aspiration. One patient who suffered with severe pneumothorax had chest drain insertion. No unilateral stabilizing bar displacement and incision infection was found during the follow-up. Conclusions Nuss procedure, with implantation of semi permanent metal bars, can safely and effectively correct pectus excavatum.