经胸腔镜单切口改良Nuss手术治疗漏斗胸3例报告

Report of 3cases of pectus excavatum treatment with modified Nuss surgery in single-port VATS

目的:总结经胸腔镜单切口改良Nuss手术治疗漏斗胸的临床经验,为其在临床上应用提供依据。方法:选取2014年7-12月在本院胸外科采用单切口改良Nuss手术治疗的3例漏斗胸患者为研究对象,其中男性2例,年龄分别为10和15岁;女性1例,年龄为11岁。全组3例患者均采用右侧胸壁2cm横行单切口,胸腔镜辅助下,由矫形板代替引导器一次性通过胸骨后间隙至左胸壁,术后常规不留置胸腔闭式引流。结果:3例患者均顺利完成手术,手术时间分别为19、26和28min,手术费用分别为3.5、3.6及3.8万元,均无麻醉意外及损伤。其中1例患者术后出现右侧少量气胸,经胸腔留置微管引流后痊愈。术后随访6个月,3例患者均矫形满意,未发生矫形板移位。结论:单切口改良Nuss手术治疗漏斗胸创伤小,更为美观,安全易行。手术的短期效果确切,中远期效果仍需进一步观察和随访。

Objective： To summarize the clinical experiences of the modified Nuss surgery in single-port VATS in treatment of pectus excavatum, and to provide basis for its clinical application. Methods： 3 patients with pectus excavatum underwent modified Nuss surgery in single-port VATS from July 2014 to December 2014 in China-Japan Union Hospital were selected. Among them 2 patients were males with 10 years old and 15 years old, respectively; and 1 patient was female with 11 years old. In the three patients, the single 2-cm long transverse incisions were made in the right lateral chest wall, a convex steel bar advanced across the mediastinum under the sternum once without guide, the chest drainage tube was not necessary after operation. Results： Deformities of all patients were successfully corrected, the time of operation was 19, 26 and 28 min, respectively; the expenditure of operation was 35, 36 and 38 thousands RMB. All the patients had no anesthetic accident and injuries. The small right pneumothorax occurred in 1 case, and healed by chest drainage. There was no postoperative recurrence. The patients were followed up 6 monthes after operation. The curative effect was satifactory without displacement of convex steel bar. Conclusion= The modified Nuss surgery in single-port VATS for the correction of pectus excavatum is more minimally invasive and beautiful, which is safe, effective and easy to perform. The excellent short-term results are obtained, and the long-term results require further evaluation.