胸腔镜辅助下Nuss手术治疗漏斗胸的临床研究

Thoracoscopic-assisted Nuss operation in treatment of pectus excavatum

目的总结胸腔镜辅助下改良Nuss手术治疗漏斗胸的初步经验。方法 18例漏斗胸患者均在气管插管全麻下手术。双侧胸壁做横行切口,在胸腔镜下将塑形之矫形板由右胸腔经胸骨后穿至左侧胸腔,翻转矫形板,将胸骨抬起矫正胸骨凹陷,矫形板两侧用固定片固定于肋骨。矫形板放置2年后取出。结果 18例均顺利完成手术,手术时间40-70 min,平均55 min。术中出血量10-20 mL,平均15 mL。术后气胸2例,皮下气肿3例。术后住院5-10 d,平均7 d。术后疗效评定,优14例,良2例,优良率89%。结论 Nuss手术矫治先天性漏斗胸安全有效、创伤小、操作简单,手术时间短,术后恢复快,近期效果满意,胸腔镜监测可提高手术的安全性。

Objective To summarize the early experience of thoracoscopic-assisted Nuss operation in treatment of pectus excavatum.Methods All 18 operations were performed under general anesthesia with endotracheal intubation.A transverse incision was made in each lateral chest wall.A steel bar was passed under the sternum from the right thoracic cavity under thoracoscope.Then the bar was turned over to raise the sternum to the normal position,fixed with bilateral costal bones by using two stabilizing bars.The bar was removed 2 years after the procedure.Results The procedure was completed successfully in all the 18 patients.The operating time was 40-70min（mean,55 min）.The intraoperative blood loss was 10-20 ml（mean,15 ml）.Complications included postoperative pneumothorax in 2 patients,subcutaneous emphysema in 3 patients.The Duration of postoperative hospital stay was 5-10 d（mean,7 d）.The excellent and good rate was 89%,excellent in 14 patients and good in 2 patients.Conclusion Nuss procedure is safe,effective,microinvasive,easy to operate,and features as less operation time,quick postoperative recovery,and satisfied short-time effect.Thoracoscope survailance can enhance the safety of operation.