胸膜外Nuss术与改良Ravitch术修复漏斗胸临床疗效比较

Comparison between the extrapleural Nuss and modified Ravitch procedure for pectus excavatum repair

目的:漏斗胸是最常见的前胸壁畸形,我科室自2008年以来开展胸膜外Nuss术矫正漏斗胸。为了比较胸膜外Nuss术的长期疗效,我们将其与改良Ravitch术进行了比较。方法:从2008年至2012年,我科室共施行胸膜外Nuss术和改良Ravitch术141例。术后随访2年以上,直至拔出矫形钢板或克氏针后3月,收集所有临床指标比较两种术式的差异。结果:87名患者行胸膜外Nuss术,54名患者行改良Ravitch术,患者平均年龄7.64岁。在手术时间、术中出血量以及住院时间等指标上,胸膜外Nuss术明显小于Ravitch术(P<0.05)。两组患者术前和术后Haller指数差值没有显著性差异。胸膜外Nuss术和Ravitch术的并发症发生率为19.54%和12.96%。胸膜外Nuss术更常见皮肤溃疡和延迟愈合,Rvitch术更常见血气胸。结论:胸膜外Nuss术是一种安全、微创、简便的矫形手术,该技术简化了手术程序,缩短了手术时间,易于应用推广。

Objective：Pectus excavatum（PE） is the most common congenital chest wall deformity.We previously carried out an extrapleural Nuss procedure through a non-thoracoscopic extrapleural approach for PE repair.To assess the repair efficacy and safety of this modified procedure in a long follow-up period,comparison between the extrapleural Nuss method and the modified Ravitch procedure was performed.Methods：We selected 141 patients with PE to receive the modified Nuss or classic Ravitch procedure at our institution from 2008 to 2012.After the second surgery for bar or Kirschner wire removal,clinical and prognostic outcomes were compared between two groups.Results：There were 87 patients in modified Nuss group and 54 in Ravitch group with an average age of7.64 years.The operative time,blood loss and hospitalization time of modified Nuss procedure were significantly lower than that in Ravitch group（P0.05）.With respect to cosmetic efficacy,the Haller index differences before and after receiving repair for PE showed no difference between two procedures.The overall complication rates of the modified Nuss and Ravitch surgery were 19.54%and 12.96%respectively.The most frequent complication was skin necrosis in Nuss group rather than pneumothorax and hemothorax in the Ravitch procedure.Conclusion：It suggested that the non-thoracoscopic extrapleural modification of the Nuss procedure was a safe and less traumatic procedure for the correction of the PE in selected patients.