新改良Nuss手术矫治先天性心脏病术后漏斗胸的病例对照研究

Efficacy of novel modified Nuss procedure in treatment of pectus excavatum after congenital heart disease operation: A case control study

目的探索新改良Nuss手术矫治先天性心脏病术后漏斗胸的效果。方法选择2011年1月至2015年3月我科先天性心脏病术后漏斗胸患儿36例(观察组),其中男22例、女14例,年龄2.8~18.0(4.5±2.2)岁。另外连续性选取2013年7~9月非先天性心脏病的漏斗胸患儿38例(对照组),男24例、女14例,年龄2.8~20.0(4.0±2.5)岁。两组患儿均行新改良Nuss手术。观察两组患者手术时间、术中出血量、术后住院时间及相关并发症。结果观察组手术时间为50~72(60.50±3.60)min,术中出血量5~10(5.82±0.35)ml,术后住院时间4~6(4.41±0.80)d。对照组手术时间为12~45(20.15±0.68)min,术中出血量3~8(4.62±0.28)ml,术后住院时间4~7(4.61±0.63)d。观察组手术时间明显长于对照组(P<0.05),两组术中出血量、术后住院时间差异无统计学意义(P>0.05)。两组均无心脏破裂等严重并发症。结论新改良Nuss手术治疗先天性心脏病漏斗胸安全可行、效果良好。

Objective To explore the feasibility and efficacy in therapy of pectus excavatum using novel modified Nuss procedure after congenital heart disease （CHD） operation. Methods Thirty-six children （including 22 males and 14 females with an average age of 4.5±2.2 years ranging 2.8-18.0 years） with pectus excavatum after CHD operation from January 2011 to March 2015 were selected as an observation group. Thirty-eight pectus excavatum children （including 24 males and 14 females with an average age of 4.0±2.5 years ranging 2.8-20.0 years） without CHD from luly to September 2013 were selected as a control group. The novel modified Nuss procedure was performed on the patients in both groups. The operation time, intraoperative blood loss, hospital stay as well as postoperative complications between two groups were reviewed and analyzed. Results In the observation group, the operation time was 50-72 （60.50±3.60） min and hospital stay was 4-6 （4.41±0.80） d. Meanwhile, the intraoperative blood loss was 5-10 （5.82±0.35） ml. In the control group, the operation time was 12-45 （20.15±0.68） min, hospital stay was 4-7 （4.61±0.63） d and the intraoperative blood loss was 3-8 （4.62±0.28） ml. The operation time was significantly longer in the observation group than that in the control group （P〈0.05）. But there was no significant difference in intraoperative blood loss or hospital stay between the two groups （P〉0.05）. No cardiac rupture happened in the two groups. Conclusion The novel modified Nuss procedure is safe and feasible for pectus excavatum after CHD operation with optimal outcomes.