胸腔镜下漏斗胸微创矫治术(Nuss手术)112例

目的:总结胸腔镜下漏斗胸微创矫治术(Nuss手术)治疗小儿漏斗胸(pectus excavatum,PE)的临床经验。方法:2005年7月～2012年9月采用胸腔下Nuss手术治疗漏斗胸112例,年龄3～21岁,平均13.6岁。其中对称性PE71例,不对称性PE41例。结果:112例均顺利完成手术,没有严重的并发症和死亡率。手术时间40～85分钟,平均51.5分钟,术中出血均少于20ml。住院时间4～8天,平均5.3天。早期并发症包括3例气胸,1例经穿刺抽气治愈,2例没有特殊处理而自行吸引。晚期并发症包括2例支撑架移位,1例重新手术矫正,另一例没有特殊处理。已有83例术后满2年患者取出支撑板,术后评价:优71例(85.5%),良10例(12.0%),一般2例(2.4%)。结论:胸腔镜下Nuss手术治疗漏斗胸手术时间短,出血少,创伤小,并发症少,效果满意,是一种操作简便、安全、可靠的治疗方法,值的大力推广。

Objectives To access the advantages of thoracoscopy-assisted minimally invasive surgery for repair of pectus excavatum(Nuss procedure) in children.Method 112 cases of pectus excavatum(PE) were performed by Nuss procedure with thoracoscope from July 2005 to September 2012,the age ranged from 3 to 21 years with an average of 13.6 years.In these patients,71 cases had symmetric PE and 41 cases had asymmetric one.Results All operations were successfully performed without severe complications and mortality.The operating time ranged from 40 to 85 minutes with an average of 51.5 minutes.Intraoperative blood loss was less than 20 ml.Length of hospital stay ranged from 4 to 8 days with an average of 5.3 days.The early complication included 3 pneumothorax cases,one was cured by air extraction with puncture,other two patients recovered without treatment or by self absorbing.The late postoperative complications included displacement of the strut(2 patients).One was received a secondary Nuss operation,the other one required no special treatment.The bar had been removed in 83 cases 2 years after operation.Initial postoperative results were excellent in 71 patients(85.5%),good in 10 patients(12.0%),and fair in 2 patients(2.4%).Conclusion Thoracoscopy-assisted Nuss procedure is a safe and reliable technique for repair of PE.It is easy to perform,with short operating time,less blood loss,minimal invasion and fewer postoperative complications.