观察改良Ravitch手术与Nuss手术矫正漏斗胸的早期疗效

Early outcomes of modified Ravitch procedure versus Nuss operation for repair of pectus excavatum

目的:分别观察采用两种改良Ravitch和Nuss手术方式矫治漏斗胸的早期临床效果。方法:收集中山大学附属第一医院胸外科2001年3月至2008年3月接受漏斗胸矫治术的52例患者的临床资料,其中改良Ravitch手术36例,Nuss手术16例,回顾分析两种术式的手术情况、术后并发症和矫形满意度。结果:52例患者均顺利完成手术。改良Ravitch手术组的平均手术时间为(96.66±25.65)min,Nuss手术组为(54.32±12.72)min,差异有统计学意义(P<0.05);术中平均出血量在改良Ravitch手术组为(85.23±30.54)mL,Nuss手术组为(30.57±10.43)mL,差异有统计学意义(P<0.05);术后引流量、术后平均住院日在Nuss手术组分别为(60.25±20.38)mL、(7.13±1.24)d,明显低于改良Ravitch手术组的(180.25±32.55)mL、(14.25±2.65)d,差异有统计学意义(P<0.05);改良Ravitch手术组出现的并发症为胸腔积液(1例)、气胸(1例)、切口愈合不良(1例),并发症发生率8.33%;Nuss手术组出现的并发症为胸腔积液(1例)、皮下气肿(1例),并发症发生率12.50%。两组并发症经处理后均顺利恢复;术后外形矫正满意度无明显差别。结论:Nuss手术矫治漏斗胸术可以显著降低手术创伤,切口小、隐蔽,手术时间短、出血少、术后恢复快。随着微创技术的成熟,Nuss手术将成主流术式。

Objective： To investigate the early outcomes of modified Ravitch procedure versus Nuss operation for repair of pectus excavatum. Methods ： Data of 52 patients who underwent repair of peetus excavatum in our hospital between March 2001 and March 2008 were included in this study. The patients comprised 36 cases treated with modified Ravitch procedure and the other 16 with Nuss operation. The surgical procedures, postoperative complications and cosmetic patient satisfaction were reviewed. Results： The operations were successful in all of 52 patients. The mean operation time was （ 96. 66 -＋ 25. 65 ） min in modified Ravitch operation group vs （54.32 ~ 12.72） min in Nuss operation group （P 〈0.05）. Mean blood loss was （85.23 ~ 30.54） mL in modified Ravitch operation group vs 30.57 ＋ 10.43 ml in Nuss operation group （P 〈 0.05 ）. The postoperative drainage and mean hospital days were （ 60.25 ~ 20.38 ） mL and （ 7. 13 ~ 1.24 ） days in Nuss operation group vs （ 180.25 ~ 32.55 ） mL and （ 14.25 ~ 2.65 ） days in modified Ravitch operation group （ P 〈 0. 05 ）. The overall incidence of complications was 8.33% in modified Ravitch operation group, including 1 case of pleural effusion, 1 of pneumothorax and 1 of poor wound healing, compared with 12.50% in Nuss operation group, including 1 case of pleural effusion and 1 of subcutaneous emphysema. All complications in these two groups were managed successfully. Cosmetic patient satisfaction was not different between two groups. Conclusion： The Nuss operation is associated with less morbidity, smaller or covert incisions, shorter operationtime, less blood loss and quicker recovery for treatment of pectus excavatum. Along with advancement in minimally invasive procedure, Nuss operation will become one of prevailing surgical approaches.