胸膜外Nuss手术与Nuss手术对比研究

Thoracoscopic extrapleural Nuss procedure versus traditional intrapleural Nuss procedure： a case control study

目的前瞻性对比胸膜外Nuss手术和Nuss手术的安全性和可行性。方法2008年7月至2009年6月252例行Nuss手术者，排除漏斗胸复发、有合并症同期手术、大于13岁、广泛凹陷使用双支撑架和极重度和严重非对称性者，余131例随机分两组，62例胸膜外Nuss手术组和69例Nuss手术组。比较两种术式围手术期情况、并发症和手术效果，并观察胸膜外组钢板是否确在胸膜外。结果131例均顺利完成手术，在两组年龄、Haller指数差异无统计学意义的前提下，手术优良率、手术时间、术中出血量和出脚寸间差异亦均无统计学意义。随访14～26个月，无复发及远期并发症，两组并发症各3例，差异无统计学意义。胸膜外组32例破入胸腔。结论胸膜外Nuss手术是安全可行的，但与Nuss手术组在手术时间、术中出血、出院时间和手术效果上无任何优势，且不容易观察到对侧胸腔情况，手术疗法不容易掌握和推广。

Objective To compare the safety and feasibility of thoracoscopic extrapleural Nuss procedure with traditional intrapleural Nuss procedure. Methods Total 252 patients with pectus excavatum received Nuss surgery from July 2008 to June 2009 in Beijing children＇s hospital. Patients had following condition were excluded： （1）recurrent pectus exeavatum; （2） complicated with other diseases, and need sinmhaneous surgery ; （ 3 ） older than 13-year-old ; （ 4 ） extensive depression, and need two Nuss bar; or （5）extreme severe or severe unsymmetrie. 131 cases were selected in our study and they were randomly divided into two groups, thoraeoseopie extrapleural Nuss procedure （ n = 62） and traditional intrapleural Nuss procedure （ n = 69）. Perioperative information, postoperative complications, effectiveness and the location of the Nuss bar were compared between two groups. Results All the 131 patients had completed the procedure successfully. There were no significant differences in age, Hailer index; surgical effects, operation time, blood loss, and hospital stay, between two groups. Postoperative complications between the two groups are not significant. 131 patients were followed up from 14 to 26 months, and no recurrence and long-term complications occurred. About more than half cases of extrapleural Nuss procedure group were break the pleural into thoracic cavity. Conclusion Both extrapleural and intrapleural Nuss procedure are safe and effective for pectus excavatum, but extrapleural Nuss procedure have no advantage to the intrapleural Nuss procedure, also it＇ s hard to observe the other side of thoracic cavity during the surgery, and not easy to grasp and to promote.