152例成人漏斗胸的微创治疗——近期并发症分析及处理

Minimally Invasive Correction of Pectus Excavatum in 152 Adult Patients:Early Complications and Management

目的总结微创矫治成人漏斗胸手术的并发症发生原因及处理经验。方法 2007年6月～2010年6月,微创治疗152例成人漏斗胸,对称型83例,非对称型69例。漏斗胸指数3.2～11.8,(4.42±1.56)。141例初治者在胸腔镜监视下手术,11例复发者剑突下小切口辅助,将矫形板置入胸骨后。结果全部顺利完成手术,用1根矫形板124例(81.6%),2根28例(18.4%)。无心脏大血管损伤及死亡。手术时间60～120 min,(70±16)min。术中出血量10～30 ml。术后住院时间5～16 d,(7.0±2.3)d。术后随访12～36个月,其中>24个月123例。按Nuss标准,优秀率86.8%(132例),良好率11.8%(18例),中等1.3%(2例)。术中一侧肋间肌撕裂5例(3.3%),均发生在非对称型重度患者,均为1根矫形板,3例支撑杆改经皮下穿出,另2例肋间肌撕裂轻未处理。支撑杆移位3例(2.0%),发生在术后1～8周,均发生在非对称型重度患者,其中2根支撑板2例,1根者1例,3例均需再手术将移位支撑杆复位并与肋骨固定。血胸2例(1.3%),其中1例需胸腔镜辅助清除胸腔残存积血。左侧自发性气胸1例,再次胸腔镜辅助肺大疱切除。结论 成人漏斗胸微创矫治手术并发症与漏斗胸的类型和凹陷程度有关,一旦发生应积极治疗。

Objective To study the causes and management of early complications of minimally invasive correction of pectus excavatum（PE） in adults. Methods Totally 152 adult patients with PE,including 83 cases in symmetry type and 69 cases of asymmetry type were admited to our hospital from June 2007 to June 2010.The PE index of the patients ranged from 3.2 to 11.8 with a mean of 4.42±1.56.Among the cases,initial correction was performed on 141 patients under the monitor by video assistant thoracoscopy（VATS）;in the other 11 patients,who had recurrent PE,the correction was carried out with the assistance by a small incision below the xiphoid.In all the cases an orthopaedic strut was inserted behind the sternum. Results The correction in the 152 patients were completed successfully;124 of them（81.6%） received one strut,the other 28 patients（18.4%） received two.No cardiovascular injury or death occurred in our patients.The operation was finished in 60 to 120 minutes with a mean of（70±16） min.During the operation,the blood loss ranged from 10 to 30 ml.The patients were discharged from our hospital in 5 to 16 days after the surgery [mean,（7.0±2.3） days],after which they were followed up for 12 to 36 months（24 months in 123 cases）.According to the Nuss,the excellent rate was 86.8%（132 cases）,good 11.8%（18 cases）,and fair 1.3%（2 cases）.During the operation,intercostal muscle tear occurred in 5 patients（3.3%）,who were asymmetry type of PE with one strut;in three of them,we inserted the supporting bar subcutaneously;and the other two cases,who had mild muscle tear,received no management.Displacement of supporting bar occurred in 3 cases（2.0%） in 1-8 weeks after the operation,who were asymmetry type with two struts（2 cases） or one struts（1 case）,and they received a second operation to replace the strut and fix it on the rib.Hemothorax was detected in 2 patients（1.3%）,and one of them needed VATS to remove coagulated hematocele.Left spontaneous pneumothorax was found in one case,who then received another thoracoscopic-assisted resection of the bullae.Conclusions Complications of minimally invasive correction of PE in adults are related to the type and severity of PE.Active management is a must when the complications occur.