胸腔镜辅助改良Nuss手术治疗儿童漏斗胸临床疗效的单中心回顾性分析

Clinical efficacy of thoracoscopy-assisted modified Nuss procedure in children with pectus excavatum:A retrospective analysis in a single center

目的探讨胸腔镜辅助改良Nuss手术治疗儿童漏斗胸的临床疗效。方法回顾性纳入大坪医院胸外科2013年10月—2020年10月行改良漏斗胸Nuss微创矫形术患儿。分析患儿的临床疗效。结果共纳入86例患儿,其中男79例、女7例,平均年龄(14.03±3.36)岁。全组患儿均顺利完成手术,平均手术时间(87.30±33.45)min,出血量(19.94±14.60)mL,术后住院时间(6.89±2.59)d。无术中心脏血管损伤及围术期死亡。术后2例患儿出现少量气胸;2例患儿部分切口脂肪液化、裂开;2例患儿出现矫形板严重翻转、移位,行二次手术治疗后愈合;1例患儿术后1年出现矫形板移位,行二次手术。总并发症发生率8.14%。随访3~42个月,矫形板取出时间均在术后36个月左右,矫形效果评估:优68例(79.07%),良10例(11.63%),中5例(5.81%),差3例(3.49%)。结论采用改良Nuss微创矫形术对漏斗胸患儿进行微创化、个体化塑形和手术,取得满意的效果,值得临床推广应用。

Objective To explore the clinical efficacy of thoracoscopy-assisted modified Nuss procedure for pectus excavatum(PE)in children.Methods The clinical data of patients with PE who underwent thoracoscopy-assisted modified Nuss procedure from October 2013 to October 2020 in Daping Hospital were retrospectively analyzed.Results A total of 86 patients were collected,including 79 males and 7 females with a mean age of 14.03±3.36 years.The operations were performed successfully in all patients without intraoperative cardiac vascular injury or perioperative death.The mean operation time was 87.30±33.45 min,bleeding volume was 19.94±14.60 mL,and the postoperative hospitalization stay time was 6.89±2.59 d.Early postoperative complications included 2 patients of pneumothorax,2 patients of wound fat liquefaction and infection,2 patients of bar flipping and displacement.One patient had bar displacement 1 year after the surgery.The total complication rate was 8.14%.All patients were followed up for 3-42 months.The bars were taken out about 36 months after the surgery.According to the evaluation criteria of orthopedic effect,68(79.07%)patients were excellent,10(11.63%)patients were good,5(5.81%)patients were moderate and 3(3.49%)patients were poor.Conclusion Minimally invasive and individualized shaping via the Nuss procedure for PE children is safe and convenient,with satisfied effect.It is worthy of popularization in the clinic.