改良Nuss术治疗小儿漏斗胸905例

Modified Nuss procedure for correction of pectus excavatum in children: a report of 905 cases

目的总结漏斗胸手术方法、并发症及相关临床经验。方法选择2004年1月至2016年12月胸腔镜辅助下改良Nuss术治疗905例漏斗患儿,其中男708例,女197例。年龄3岁8个月~17岁(9.35±4.17)岁,合并畸形25例(2.76%)。结果 905例均顺利完成手术,手术时间25~80(41±9)min,出血量1~20ml,术后住院平均5.5d。发生早期并发症共52例(5.75%,发生2种及以上并发症11例),其中心包损伤15例(1.66%),气胸18例(1.99%),胸腔积液12例(1.33%),切口愈合不良10例(1.10%),应激性溃疡12例(1.33%)。发生晚期并发症16例(1.77%),其中脊柱侧弯和(或)支架移位8例(0.88%),过敏8例(0.88%)。68例(7.51%)患儿发生并发症,共83例次。近2年内并发症发生明显减少,无心包损伤、二次手术、支架移位等严重并发症。随访3个月至10年,矫形效果达优良者695例(96.4%)。结论改良胸腔镜辅助下Nuss术治疗儿童漏斗胸安全可行,矫形效果满意,改良后手术方式更安全,切口更美观,手术更微创。对于Haller指数>4,不对称型患儿,术前/术中胸壁负压盘的应用可减少并发症的发生,简便易行,是一种可为改良Nuss术提供安全保障的辅助方法。患儿手术最佳时机为6~12岁,可扩展至3.5~17岁,远期效果良好。

Objective To review the clinical experience of modified Nuss procedure in treatment of pectus excavatum in children.Methods From January 2004 to December 2016, 905 children with pectus excavatum were surgically corrected by modified Nuss procedure in our hospital. There were 708 boys and 197 girls, and 25 patients（2.76%） associated with other malformation. The average age was 9.35 ±4.17 years（3 years and 8 months to 17 years）. Results All surgery were successful, with the mean operation time of 41 mins（25-80 mins）.The intraoperative blood loss was 1-20 ml. The average of post-operative hospital stay was 5.5 days. The rate of complication was 7.51%. The earlier postoperative complication included 15 cases of pericardium injury（1.65%）, 18 cases of pneumothorax（1.99%）, 12 cases of hydrothorax（1.33%）, 10 cases of poor incision healing（1.10%）and 12 cases of stress ulcer（1.33%）. The late complications included scoliosis and stabilizing bar displacement caused by persistent pain（n=8, 0.88%） and allergy（n=8, 0.88%）. The rate of complication was significantly decreased in recent two years, there were no heart and pericardium injury, stabilizing bar displacement and second operation. The duration of follow-up was 3 months to 10 years, postoperative evaluation showed that the excellent rate was 96.3%. Conclusion The Nuss procedure is safe and effective for correcting the children＇s pectus excavatum, the modified Nuss procedure is safer and less invasion with smaller incision. Our experience shows that the modified Nuss procedure is the best choice for the patients with severe symmetry funnel chest, specially with flat chest wall.