胸腔镜辅助微创手术(改良型Nuss术)矫正治疗小儿漏斗胸的临床疗效

Clinical effects of thoracoscopy-assisted modified Nuss procedure on children with pectus excavatum

目的探讨胸腔镜辅助微创手术(改良型Nuss术)矫正治疗小儿漏斗胸的临床疗效。方法选择2012年1月至2019年12月,在新疆医科大学第一附属医院小儿心胸外科接受胸腔镜辅助微创手术(改良型Nuss术)治疗的174例漏斗胸患儿为研究对象,并纳入研究组(Haller指数为3.76~11.23)。选择2002年1月至2010年1月,在同一家医院接受传统胸骨翻转术治疗的37例漏斗胸患儿纳入对照组(Haller指数为3.28~18.30)。采用成组t检验对2组患儿年龄、Haller指数、手术持续时间等呈正态分布的计量资料;采用秩和检验对其住院时间等呈非正态分布的计量资料;采用χ^(2)检验对性别构成比、并发症发生率、复发率等计数资料,进行统计学分析。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。对所有患儿及其家属详细说明术中、术后可能发生的并发症,并与之签署手术知情同意书后行手术矫形。结果①2组患儿性别构成比、年龄、Haller指数等一般临床资料比较,差异无统计学意义(P>0.05)。②研究组患儿手术持续时间为(26.6±4.5)min、住院时间为8.0 d(7.0~9.8 d),均短于对照组(135.0±24.2)min,39.0 d(37.0~42.8 d),并且差异有统计学意义(t=21.441、Z=35.748,P<0.001)。研究组患儿并发症发生率[8.6%(15/174)]和复发率(0),均分别低于对照组[24.3%(9/174)、18.9%(7/37)],并且差异亦均有统计学意义(χ^(2)=5.988、28.406,P=0.014,<0.001)。③研究组15例(8.6%,15/174)患儿发生并发症的时间分别为术中(1例)与术后早期(≤30 d,10例)和术后晚期(>30 d,4例)。④对2组患儿术后共随访2个月至7年的患儿满意度,研究组(98.3%,171/174)高于对照组(91.9%,34/37),并且差异有统计学意义(χ^(2)=4.501,P=0.034)。结论相较于传统胸骨翻转术治疗,胸腔镜辅助微创手术(改良型Nuss术)矫正治疗小儿漏斗胸具有操作简单、手术持续时间短,切口小且隐蔽、术后恢复快等优点,并且术后患儿满意度较高。

Objective To investigate clinical effects of thoracoscopic modified Nuss procedure in the treatment of pectus excavatum.Methods From January 2012 to December 2019,174 children with pectus excavatum who underwent thoracoscopic modified Nuss procedure in the First Affiliated Hospital,Xinjiang Medical University were selected into this study(study group).Another 37 children with pectus excavatum who underwent traditional sternal turnover surgery from January 2002 to January 2010 in the same hospital were enrolled into control group.The Haller index of two groups were 3.76-11.23 and 3.28-18.30,respectively.Age,Haller index and operation duration were statistically analyze by independent-samples t test.Length of stay was statistically analyzed by rank sum test.Comparisons of gender ratio,complication rates and recurrence rates between two groups were performed by chi-square test.The procedures followed in this study were conformed to requirements of World Medical Association Declaration of Helsinki revised in 2013.For all participants,written informed consent was obtained from both parents regarding participation of child/adolescent and one from the participating parent.Results①There were no significant differences between two groups in composition ratio of gender,age and Haller index(P>0.05).②The operation duration[(26.6±4.5)min]and length of stay[8.0 d(7.0-9.8 d)]in study group were shorter than those in control group[(135.0±24.2)min,39.0 d(37.0-42.8 d)],and the differences between two groups were statistically significant(t=21.441,Z=35.748;P<0.001).Besides,the complication rate[8.6%(15/174)]and recurrence rate(0)in study group were lower than those in control group[24.3%(9/174),18.9%(7/37)],and the differences between two groups were statistically significant(χ^(2)=5.988,P=0.014;28.406,<0.001).③Of these 15 children(8.6%,15/174)in study group who had complications,1,10,and 4 children were during intraoperative,early postoperative(≤30 d),and late postoperative(>30 d),respectively.④Patients in two groups were followed-up for 2 months to 7 years after surgery,and the satisfaction degree in study group(98.3%,171/174)was higher than that in control group(91.9%,34/37),and the difference was statistically significant(χ^(2)=4.501,P=0.034).Conclusions Thoracoscopic modified Nuss procedure for pectus excavatum has the advantages of simple operation,short operation duration,small and hidden incision,quick postoperative recovery,and high satisfaction.