非胸腔镜下Nuss矫正术治疗漏斗胸

Nuss procedure for the correction of pectus excavatum in children without thoracoscopy

目的探讨非胸腔镜下微创Nuss术矫正漏斗胸的安全性、有效性和治疗经验。方法2007年10月至2009年5月，手术治疗48例漏斗胸病儿中男28例，女20例；年龄4～13岁，平均（6．5±2．1）岁。术前CT示胸廓指数3．76±0．54；其中26例行非胸腔镜下微创Nuss术（非胸腔镜组），22例行胸腔镜辅助下Nuss术（胸腔镜组）。结果两组均顺利完成手术，术中均无死亡、大出血及胸腔脏器损伤等严重并发症发生。非胸腔镜下Nuss组无气胸，血胸等并发症，无需放置胸腔闭式引流管。其手术时间、术后人院时间与胸腔镜组比较，差异有统计学意义（P〈0．05）。非胸腔镜下Nuss组手术时间24～38min，平均（25．4±2．6）min；住院3～6天，平均（4．5±1．1）天；术中出血量5～10ml。胸腔镜组手术时间40～60min，平均（53．5±3．4）min，住院5～8天，平均（7．0-4-2．2）天；出血量10～15ml。两组病儿术后均获随访，随访时间至少3个月，平均10．4个月，均无漏斗胸复发。非胸腔镜手术组1例术后2月出现肋骨矫形板移位，再次手术重新放置肋骨矫形板。结论非胸腔镜下Nuss术矫正漏斗胸是安全有效的，与胸腔镜辅助下Nuss术相比创伤更小，恢复更快。

Objective The aim of this study was to evaluate the efficacy and safety of the approach of the Nuss procedure for the correction of pectus excavatum in children without thoracoseopy. Methods From Oct 2007 and May 2009,48 patients with pectus excavatum underwent Nuss procedure. Among them 22 were done under the thoracoscopic guidance, and the other 26 in a non-thoracoscopic way,in which, a bilateral extrapleural tunnel to the edge of sternum was created using a blunt dissection via a bilateral thoracic skin incision. Without introducing the tboracoscopy into the thoracic cavity, a steel bar was inserted in the entirely cxtrapleural tunnel and turned as the standard Nuss procedure. Results All 48 patients recovered uneventfully. There were no postoperative deaths and serious complications. A single alloy steel bar （23-40 cm） was used in all patients. In the non-video-assisted extrapleural group （ n = 26 ）, no pneumothorax occurred, the operating time （ after anesthesia） ranged from 24 -38 minutes [ mean （25.4 ±2.6） rains] , blood loss was minimal （range, 5-10 ml） , and the hospital stay was ranged from 3-6 days [ mean （4.5± 1.1 ） days]. In the thoraeoscopic group （ n =22）, the corresponding figures were 40 to 60 minutes [ mean （53.5 ± 3.4 ） mins） ], 10 to 15 ml, 5-8 days E mean （7.0 ± 2.2） days ], respectively. No recurrent of the funnel chest occurred during the 3-18 months （ median 10.4 monthes） of follow-up. The bar displacement occurred in 1 case 2 months after operation, which was replaced with satisfied result. Conclusion The non-thoracoscopic approach of the Nuss procedure is a safe and less traumatic procedure for the correction of pectus excavatum.