Wang手术用于低龄漏斗胸治疗

Experience withWang procedure for treatment of pectus excavatum in young children

目的对低龄漏斗胸患儿使用Wang手术的经验进行总结。方法对21例低龄漏斗胸患儿使用Wang手术的临床资料做分析。于剑突前方做正中纵行切口,切口长1～2 cm,于肌肉深层向两侧胸壁做钢板隧道,于胸骨后对膈肌与胸骨之间的纤维组织做游离。以钢丝从剑突下方经凹陷胸壁的深面做贯穿缝合,将一条特制钢板放入骨性结构表面的隧道中,提拉钢丝,并将其固定于钢板中部,缝合切口,完成手术。结果本组均以3条钢丝做缝合固定,术中放置1条钢板,手术时间25～51(38.1±9.6)min;术中出血5～10(7.1±1.5)mL;住院天数为6～10(8.1±1.3)d。术后切口愈合良好,无严重疼痛,无明显并发症。术后对所有患儿均做随访,随访时间1～13月。随访期间未见凹陷复发,未见钢板移位、转位等并发症。依据漏斗胸术后评价标准做效果评价,总分9分者13例,总分8分者8例,效果均非常满意,无基本满意和不满意病例。结论对于低龄漏斗胸患儿,Wang手术是一个较为理想的选择。

Objective To review the experience with Wang procedure for treatment of pectus excavatum in young children. Method The clinical data of 21 children with a mean age of 3.3 ± 1.1 years (ranging from 1.5-6 years) undergoing Wang procedure for pectus excavatum were analyzed. A longitudinal incision (1 to 2 cm) was made in the front of the xiphoid, and two tunnels were created using steel bars beneath the muscles on two sides of the chest wall. The fibrous tissue between the diaphragm and the sternum was dissociated, and the steel wires were sutured through the deformed chest wall. After the steel bar was placed in the tunnels, the wires were pulled and fixed in the middle of the bar, and the incision was sutured. Results All the operations were performed using 3 wires and 1 steel bar. The operation time was 25 to 51 (38.1 ± 9.6) min with an intraoperative bleeding volume of 5 to 10 (7.1±1.5) mL. The time of hospitalization of the patients ranged from 6 to 10 days (mean 8.1±1.3 days). In all the patients, the incision healed smoothly without serious pain or obvious complications. All the patients were followed up for 1 to 13 months after the operation. During the follow- up, no recess recurred and no such complications as bar displacement or transposition occurred. According to the evaluation criteria after pectus excavatum operation, 13 cases had a total score of 9, and 8 had a total score of 8. The overall effect was satisfactory, and there were no cases rated as basically satisfactory or unsatisfactory. Conclusion Wang procedure is a good option for treatment of pectus excavatum in young children.