指触引导技术在Nuss手术中的应用

Application of a finger-guided technique in Nuss procedure

目的探讨新设计的指触引导技术在Nuss手术中的应用,并分析该技术的可行性、便捷性及安全性。方法回顾性分析2012年1月-2015年12月期间收治的76名漏斗胸患者,将其分为指触组(34例)和对照组(42例)。指触组是在Nuss手术中做双侧腋前线20 mm切口,并建立皮下隧道进胸,手指探查胸腔,在胸骨后与对侧胸腔的扩展钳尖端接触,在确认其间无心、肺、膈肌等重要组织后,扩展钳在手指引导下穿过胸骨后组织到相应位置,从而避免心、肺等组织损伤,术中不使用胸腔镜及钢板固定器。对照组采用经典的Nuss术式。本文将两组患者的围术期情况、主要并发症的发生率和术后满意度进行对比分析。结果 76例患者顺利完成手术,平均手术时间及术后平均住院天数指触组<对照组,(39.10±10.01)min vs(70.15±12.87)min,P=0.028,(2.81±0.71)d vs(4.01±0.81)d,P=0.048。主要并发症发生率指触组<对照组(8.82%vs 26.19%)。两组患者的术后满意度差异无统计学意义(P>0.05)。结论新设计的指触引导技术可最大限度地避免Nuss术中心、肺及大血管等重要脏器的损伤,此技术简单易行,值得进一步推广应用。

Objective To discuss how to avoid catastrophic complications with a newly-designed finger-guided technique in Nuss procedure, and to analyse the feasibility, convenience and security of this new technique. Methods Seventy-six patients with pectus excavatum （PE）, who received Nuss operation from January 2012 to December 2015, were retrospectively analyzed. They were separated into finger-guided group （34 cases） and control group （42 cases）. In the finger-guided group, a 20-mm skin incision was made at bilateral anterior-axillary lines and the subcutaneous tunnels were established into the thoracic cavity. The finger explored the thoracic cavity and retrosternal tissues, then touched the tip of pectus dissector in the contralateral thoracic cavity to confirm there were no important tissues such as heart, lung, diaphragm between the finger and the pliers tip. Then the pectus dissector was guided by the finger and passed through the retrosternal space. In this way, heart and lung injuries could be avoided without thoracoscopy. The perioperative condition, the incidences of major complications and postoperative satisfaction were compared between the two groups. Results The procedures were successfully completed in all the patients. The average operation time and postoperative hospital stay time in the finger-guided group were significantly shorter than those in the control group [（39.10 ± 10.01） vs （70.15 ± 12.87） min, P = 0.028; （2.81 ± 0.71） vs （4.01 ± 0.81） d, P = 0.048]. The total incidence of major complications in the finger-guided group was significantly lower than that in the control group （8.82% vs 26.19%）. There was no significant difference in postoperative satisfaction between the two groups （P 〉 0.05）. Conclusions The newly-designed technique can avoid the heart and lung injuries in Nuss procedure. This technique is simple and practicable, and worth to be widely adopted.