钢板支架纠治小儿漏斗胸

Surgical Treatment of Pediatric Pectus Excavatum by Using Stainless Steel Strut

目的研究钢板支架纠治小儿漏斗胸的方法及疗效。 方法 4～ 12岁漏斗胸患儿 89例。胸骨下端凹陷范围 6～ 12cm× 6～ 12cm ,凹陷深度 1～ 3cm。所有患儿均在气静麻醉下行双乳下弧形切口 ,采用自行设计的带翼钢板悬吊固定胸骨和肋骨。伴肺囊肿患儿同时行肺叶切除 ;伴先心患儿同时行先心根治术。 结果全组患儿无死亡病例。 1例术后并发肺炎 ,1例法洛氏四联症患儿术后并发低心排 ,1例并发乳糜胸 ,1例伤口中部干性坏疽 ,2例皮下积液、伤口渗出 ,经处理后痊愈。术后住院 8.3± 3.1d。所有患儿均经 6月～ 5年随访 ,77例患儿术后 6月～ 1年已行钢板拆除。 结论以钢板支架纠治小儿漏斗胸具有改善胸壁外观和心肺功能及减少心灵创伤的多重好处。患儿

Objective To introduce the method to insert stainless steel struts to correct pediatric pectus excavatum. Methods Between February 1988 and March 2001, 89 patients with pectus excavatum underwent corrective surgery. The surgical technique consisted a transversal skin incision below two nipples and a longitudinal sternotomy through the deepest part of the depression. The costal cartilages were then partially incised, and the sternum and the depressed ribs were fixed by the home made stainless steel struts. The lung cysts and congenital heart diseases were simultaneously operated. Results There were no operative mortality. The complications of surgical repair were superficial infection and necrosis in 3 cases and pneumonia, chylthorax, low cardiac output in each case. They were all successfully treated. The follow-up period was 6 months ～ 5 years postoperation. In 77 patients the metal struts were removed 6 ～ 12 months later. Conclusion Correction of pectus excavatum with stainless steel struts results in an excellent cosmetic outcome. It improves cardiopulmonary function and provides both physical and psychological benifits. The suitable operative age is above 4 years old.