自体力胸骨沉降法微创矫治鸡胸

Minimally invasive sternal depression by autologous force for pectus carinatum repair

目的探讨自体力胸骨沉降术微创治疗鸡胸的手术方法、可行性及手术效果。方法回顾性分析2011年10月至2015年9月武汉同济医院采用自体力沉降法微创矫治22例鸡胸患者的临床资料,其中男19例、女3例,平均年龄6~15(12.00±2.87)岁,对称性鸡胸17例,非对称性鸡胸5例。14例患者术前行胸部CT检查,Haller指数为1.65~2.23(1.97±0.15)。所有患者均采用NUSS矫形钢板,通过自身肋骨的固定作用下压突起胸骨以矫治鸡胸。结果所有患者均顺利完成手术,平均手术时间55~120(83.73±16.62)min,平均术中失血量10~50(28.18±11.63)ml,平均术后住院时间3~6(4.23±1.17)d。术后发生伤口感染2例,轻度气胸3例,均保守治疗后痊愈;单侧液气胸1例,经胸腔闭式引流术后痊愈出院。术后随访6~48个月,矫形效果良好。无术后持续疼痛。未出现钢板翻转、移位以及固定片滑脱。其中9例患者已经取出矫形钢板,取出后胸廓外形保持良好,未出现鸡胸复发。结论自体力胸骨沉降法微创矫治鸡胸较传统微创矫治术进一步简化了手术操作,手术安全可行,矫形效果良好。

Objective To investigate the feasibility and clinical outcomes of minimally invasive sternal depression by autologous force for the correction of pectus carinatum. Methods Between October 2011 and September 2015, 22 pectus carinatum patients underwent minimally invasive surgical correction of pectus carinatum in Tongji Hospital.Clinical data of 22 patients were retrospectively analyzed. There were 19 males and 3 females with a mean age of12.00±2.87 years, ranging from 6 to 15 years. Among them, 17 patients were symmetric malformation, and the others were asymmetric. Preoperative chest CT scan was performed on 14 patients. Haller index was 1.65-2.23（1.97±0.15）. All the patients underwent the minimally invasive surgical correction of pectus carinatum with a NUSS bar via sternal depression by autologous force. Results All the operations were completed successfully. The mean operation time was 55-120（83.73±16.62） min and blood loss volume was 10-50（28.18±11.63） ml. The mean postoperative hospital stay was 3-6（4.23±1.17） d. Postoperative complications included wound infection in 2 patients, minor pneumothorax in 3 patients,who were cured by conservative treatment. One patient suffering postoperative hydropneumothorax received drainage.All the patients were followed up for 6-48 months after discharge and very satisfied with the chest appearance following surgery. No patient complained of persistent pain. There was no displacement of the bar or the stabilizers. Nine patients underwent the removal of the NUSS bar without pectus carinatum recurrence. Conclusion Minimally invasive sternal depression by autologous force simplifies the procedure of correction of pectus carinatum with reliable and satisfactory outcomes.