Nuss手术矫治儿童漏斗胸252例临床分析

Nuss procedure for the correction of pectus excavatum in children:report of 252 cases

目的总结Nuss手术矫治儿童漏斗胸252例的临床经验及早中期效果。方法 2005年5月至2011年7月采用Nuss手术矫治252例漏斗胸患儿,男189例,女63例,平均年龄6.8岁(3～18岁)。根据Park分型,对称型占62.7%(158/252),不对称型占37.3%(94/252)。术前胸部CT测量Haller指数平均4.86(3.10～20.72)。不对称型漏斗胸采用个体化的钢板塑形及斜行肋间放置钢板技术。根据术后Haller指数及随访结果评价手术效果。结果全组手术顺利,手术时间平均54min(38～120min)。采用胸腔镜辅助手术247例。围术期并发症发生率为16.7%(42/252)。术后6月胸部CT测量Haller指数平均值2.68(2.12～3.55),与术前相比有显著统计学意义(P<0.01)。矫形效果为优206例,良34例,中10例,差2例,优良率95.2%。结论 Nuss手术矫治儿童漏斗胸创伤小、操作简便、并发症少,多种改良方法的应用使得Nuss手术适合儿童各种类型漏斗胸的治疗,可以达到良好的手术效果。

Objective To summarize the clinical experience and evaluate the early and mid-term results of Nuss procedure on children with pectus excavatum. Methods From May 2005 to July 2011,252 children （male 189, female 63）with pectus excavatum who underwent Nuss procedure were reviewed retrospectively,including 5 cases of recurrence after traditional surgical procedure. Their age ranged from 3 years to 18 years（mean 6.8 years）. The mean preoperative Haller index measured by CT scan was 4.86, ranged from 3. 10 to 20.72. According to the Park typing, of the 252 cases, 158 had symmetic and 94 had asymmetric pectus excavatum. The standard Nuss procedure were modified by using individual designed asymmetric shaped bar and placing bar obliquely for cases of symmetric group. Results The operations in all patients were performed successfully with one single bar utilized,except for 4 elder children with two bars utilized. The operation time ranged from 38 to 120 rain （mean 54 min）. No blood transfusion was required. The procedure was performed with the assistance of thoracoscopy in 247 cases. The incidence of perioperative complication was 16.7 %. The mean postoperative Hailer Index＇was 2.68 （ranged from 2. 12 to 3.55）, which was significantly less than the preoperative data （P^0.01）. Postoperative evaluation was ＂excellent＂ in 206 cases , ＂good＂ in 34 cases, ＂fair＂ in 10 cases, and ＂poor＂ in 2 cases. The rate of ＂excellent＂ plus ＂good＂ was 95.2%.Conclusions Nuss procedure for the correction of pectus excavatum in children has advantages such as little trauma, simple handling,less complications, etc. With the techniques of bar shaping and obliquely bar placing individually,modified Nuss procedure is suitable for the treatment of most types of pectus excavatum in children.