非胸腔镜辅助下Nuss手术治疗儿童漏斗胸的临床研究

Clinical study of pectus excavatum by non-thoracoscopic assisted Nuss procedure

目的探讨非胸腔镜辅助下Nuss手术治疗儿童漏斗胸的疗效与经验。方法 2011年3月至2016年3月本院共收治42例漏斗胸患儿,其中男性36例,女性6例;年龄3岁至15岁2个月。所有患儿术前CT评估Haller指数均≥3.4(4.36±0.63)。胸廓对称30例,不对称12例。心电图异常14例。术中采用两侧切口,均经右胸入路,放置1条钢板。25例右侧固定片固定,7例双侧固定。所有病例均用可吸收线将钢板和固定器缝合于肋骨外膜上。结果 42例均顺利完成手术,平均手术时间(70.98±12.1)min,术后平均住院时间(7.24±0.85)d,39例效果良好,2例效果不显著,1例钢板移位,2例对钢板产生过敏反应。结论 Nuss手术治疗漏斗胸创伤小,安全性好,术后恢复快,效果良好。

Objective To summarize our experiences of correcting pectus excavatum （PE） through Nuss procedure without thoracoscopic assistance. Methods From March 2011 to March 2016,42 PE patients underwent Nuss operation. There were 36 boys and 6 girls with an age range of 36 to 182 months. The preoperative CT Hailer index was ≥ 3.4 （4.36 ± 0.63 ）. Chest walls were symmetrical （ n = 30） and asymmetrical （ n = 12）. Electrocardiogram was abnormal in 14 patients. All skin incisions were made bilaterally and introducers were placed from the right incision to the left. One bar was installed. Stabilizing clips were placed at the right side in 25 cases and the others bilaterally. Bar and stabilizing clips were also secured at the periost of rib with wire sutures.Results Operations were performed successfully in 42 patients. The mean procedural duration was （70.98 ± 12.1 ） min and the mean postoperative hospitalization stay （7.24 ± 0.85 ） days. Thirty-nine cases achieved the expected results while another 2 cases failed. Bar displacement （ n = 1 ） and allergic reactions （ n = 2 ） occurred. Conclusion Nuss procedure can guarantee satisfactory outcomes and surgical safety with faster recovery and minimal trauma in PE patients.