微创手术矫治儿童漏斗胸后胸廓骨重塑与临床疗效

Thoracic Bone Remodeling and Clinical Therapeutic Effect after Minimally Invasive Repair for Pectus Excavatum in Children

目的探讨儿童漏斗胸微创手术矫治后胸廓骨的重塑及临床疗效。方法回顾性分析2009年4月至2010年9月北京军区总医院74例漏斗胸患者经微创手术矫治的临床资料,其中男63例,女11例;年龄(11.90±8.50)岁,<10岁11例。74例患者于全身麻醉下在两侧腋中线做切口,在电视胸腔镜下引导穿通器经胸骨后创出通道,并抬举胸骨成形后,再将制备好的支撑板置入胸骨后。术前和术后1周行胸部CT、胸廓CT三维重建,矢状位以胸椎体中心线为切线位,测量胸骨与胸椎体前缘的距离,并观察心脏移位恢复情况和胸廓外形。结果 74例均顺利完成手术,无手术死亡。使用1根矫形板66例(89.19%),使用2根矫形板8例(10.81%)。使用1根矫形板、年龄<10岁的11例患者术后7 d胸骨柄下端和胸骨体各部位与术前比较均向前移位3.76～22.92 mm,11～17岁的55例使用1根矫形板患者胸骨体中间和下端与术前比较分别向前移位2.08 mm和10.42 mm,两者胸骨体下端较术前向前移位的距离比较差异有统计学意义(t=14.24,P<0.05)。术后7 d时11～17岁使用2根矫形板患者胸骨柄下端和胸骨体各部位与术前比较向前移位4.19～15.03 mm。术后7 d胸部CT显示65例(87.84%)患者心脏位置恢复正常;用2根矫形板患者胸廓外观优于用1根者。随访74例,随访率100%;随访时间6～23个月,患者术前临床症状消失,胸廓外形饱满,心脏位置完全恢复正常。结论儿童漏斗胸微创手术矫治一次性成形具有良好的重塑性;随着年龄增加,矫治支撑胸骨的力也需要增加,且疗效满意。

Objective To study thoracic bone remodeling and clinical effects after minimally invasive correction for pectus excavatum（PE）in children.Methods A retrospective review was conducted of a prospectively gathered database of 74 child patients who underwent minimally invasive repair of PE at General Hospital of Beijing Military District between Apr.2009 and Sept.2010.Of the patients,63 were males and 11 females;the age was（11.90±8.50） years,11 patients 10-year-old among them.Under general anesthesia,two incisions were made at the side midaxillary line,and the introducer created a tunnel at the trans-substernum and shaped the thoracic cavity.The bar was then inserted into the retrosternum by video-assistant thoracoscopic monitoring.All patients were checked by chest computerized tomography（CT）scan preoperatively and one week after operation,with three-dimensional reconstruction.The sagittal view was by means of the center line of the body of thoracic vertebrae.The distance between the sternum and the frontal edge of the body of thoracic vertebrae was measured and the return of displacement of the heart was observed.Results All 74 operations were successful;there were no deaths.One bar was used for 66 patients（89.19%）,while two bars were used for the other 8 patients（10.81%）.Comparing the results of pre-with post-correction,for patients younger than 10 years（n=11）who had one bar placed,the inferior extremity of the manubrium and midsternum displaced forward to 3.76-22.92 mm.For 11-17 year-old patients（n=55）,anterior displacement of only the middle and lower part of the midsternum was 2.08-10.42 mm.There was a significant difference between the two groups in the inferior extremity of the midsternum displaced（t=14.24,P 0.05）.For those patients with two bars,the inferior extremity of the manubrium and the midsternum were each displaced forward 4.19-15.03 mm at 7 d after operation.At 7 d after operation,the cardiac position in 65 patients（87.84%）of the all putted back by CT image.The chest shape of patients who received two bars was better than that of patients who received one bar.After 6-23 months of follow-up,it was pre-operative symptoms disappeared in the patients,chest shape was satiation.Cardiac position in all patients was completely recovered.Conclusion The thoracic bones of children with PE after minimally invasive repair have favorable remodeling.Older children require greater strength of support of the sternum during correction,but still realize a satisfactory therapeutic effect.