成人重症漏斗胸的微创手术矫治

Nuss procedure as minimally invasive surgical correction for adult patients with severe pectus excavatum

目的:总结应用Nuss手术矫治成年重症漏斗胸患者的临床经验。方法:回顾自2006年1月到2016年6月,对20岁以上重症漏斗胸患者实施的Nuss手术,分析手术过程、并发症、术后康复及近远期矫形效果等临床资料。结果:手术患者58例,其中男性42例,女性16例,平均年龄(21.8±5.4)岁,术后复发患者11例,合并心脏疾患8例,漏斗胸Haller指数平均6.2±3.7。手术方法采用改良Nuss术。58例均顺利完成手术,同期行心脏手术8例,16例采用双支撑钢板,平均手术时间(65.3±21.7)min,术中出血(27.5±12.1)m L。术后二次开胸止血1例。患者均康复出院,术后住院时间(6.2±1.7)d。出院后随访6个月至10年,发生钢板移位1例,再次手术治愈。术后1年后矫形效果评价均为优良。37例患者已拔除钢板,无漏斗胸复发病例。结论:Nuss手术可以安全应用于矫治成年重症漏斗胸患者,临床效果满意。

Objective： To evaluate the safety and efficacy of Nuss procedure as surgical correction for adult patients with severe pectus excavatum. Methods： The clinical data of minimally invasive repair for pectus excavatum in patients older than 20 years from 2006 to 2016 were reviewed. The surgical procedure, clinical result and post-operative follow-up were recorded. Results： Fifty-eight patients （42 men, 16 women） with a mean age of （21.8 ±5.4） years and a mean Hailer index of （6. 2 ±3.7） were included. Eleven patients were repaired due to previous failed Ravitch and Nuss procedures. Modified Nuss procedures were performed in all 58 patients. Cardiac operations were performed for co-existed disorders before pectus bars were implanted in 8 cases. Two bars were required in 16 patients. The mean duration of the procedure was （65.3 ± 21.7）rain. The mean blood loss was（27. 5± 12. 1 ）mL. Hemothorax occurred in one patient who underwent concurrent Bentall procesure and needed reoperation. All patients recovered and the mean length of hospital stay was （6. 2 ± 1.7 ） days. During follow-up, pectus bar dislocated in one patient and required an operative repair. The cosmetic result were excellent and patient satisfaction was high one year post-operatively. Bars were removed in 37 patients. No recurrence of deformity happened during follow-up. Conclusion： Nuss procedure can be performed safely in adults with satisfactory effectiveness and excellent cosmetic result . Nuss procedure may serve as the first preference in adult population with severe pectus excavatum.