Nuss手术矫治复发性和胸部手术后继发性漏斗胸

Nuss procedure for recurrent and acquired pectus excavatum after open thoracic surgery

目的总结Nuss手术矫治复发性和胸部手术后继发性漏斗胸经验。方法2004年6月至2011年9月18例复发性或胸部手术后继发性漏斗胸Nuss手术者中男12例，女6例；年龄3．1～14．8岁，平均（8．8±4．0）岁；体重11—55始，平均（30．2±14．8）k。10例为开放式漏斗胸矫治术后复发病例，8例为其他胸部手术后继发性漏斗胸。16例畸形为对称性，2例为非对称性。cT检查Haller指数5．4±3．4。手术均在胸腔镜辅助下完成。结果全组均成功实施手术。所有患儿均置入1根钢板。17例置入右侧固定片，1例置入双侧固定片。16例矫形效果为优良，2例良好。矫形效果与初次Nuss手术相比，早期优良及良好率差异无统计学意义（P〉0．05）。术后胸腔引流管放置1—4天。1例钢板移位于术后5个月行Nuss修正，重新固定移位之钢板。1例心脏穿孔出血，术中紧急行扩大胸骨正中切口，直视下修补心脏破口，术后复查超声心动图，心脏功能正常，无神经系统并发症。1例术后当天气胸合并皮下气肿，1例术后3天胸腔积液，此2例均行胸腔闭式引流后治愈。12例钢板拆除，钢板滞留24～45个月，拆除者10例保持优良，2例良好，无复发病例。结论Nuss手术矫治复发性和胸部手术后继发性漏斗胸效果良好。

Objective To summarize the experiences with minimally invasive pectus repair （ Nuss procedure） for recurrent and acquired pectus excavatum after open thoracic surgery. Methods From Jun 2004 to Sep 2011, eighteen patients with recurrent or acquired pectus exeavatum underwent Nuss procedure, including 12 males and 6 females The age ranged from 3.1 to 14.8 years with mean age of （8.8±4.0） years. The body weight was 11 to 55kg with mean weight of （30.2 ± 14.8 ） kg. Ten cases were recurrent pectus excavatum with previously failed open surgery repair, eight were acquired pectus excavatum after other open thoracic surgery. Sixteen cases had symmetrical and 2 had asymmetrical pectus excavatum. Hailer＇ s index was 5.4 ±3.4. The operation was performed with thoraeoscopic assistance. Results All patients had successful operation with one bar insertion in each patient, one stabilizer was put on right side in seventeen and double stabilizers were put in one case. Therapeutic results evaluation was ＂excellent＂ in 16 cases and ＂good＂ in 2. Percentage of ＂excellent＂ and ＂good＂ was the same with that in our primary Nuss procedure （P 〉 0.05 ）. Chest drainage duration was 1 to 4 days. One case had bar displacement revision 5 months later. Heart perforation occurred in one on whom a sternotomy and perforation repair were immediately per- formed. The echocardiography exam shows normal cardiac function after operation, and no nerve system complications were detected. One developed pneumothorax on operative day and one had pleural effusion three days later, both were treated by chest tube drainage. Twelve patients＇ bars were removed after 24 - 45 months of stagnation period. Anatomic results at bar removal were 10 ＂excellent＂ and 2 ＂good＂, there were no recurrent cases. Conclusion Nuss procedure is an effective method and has good results on recurrent and acquired pectus excavatum. Safety of patients and complications minimization is always the first to be considered.