胸腔鏡輔助下Nuss手術微創矯治漏斗胸的療效觀察_《中國修復重建外科雜志》

作者：

李斌 , 張建華 , 茍云久 , 王志強 , 王成 , 宋鐵牛 , 楊建寶

蘭州大學第二醫院胸外科（蘭州，730030）;

關鍵詞：

漏斗胸 Nuss手術胸腔鏡

DOI：

10.7507/1002-1892.20130132

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目的總結胸腔鏡輔助下Nuss手術微創矯治漏斗胸的臨床療效。方法2009年9月－2012年1 月，于胸腔鏡輔助下行Nuss手術微創矯治33例漏斗胸。男26例，女7例；年齡3～22歲，中位年齡9歲。其中1例為Ravitch術后3年復發，余均為初次手術。24例有明顯臨床癥狀。Haller指數為3.3～50.1，平均5.6。漏斗胸根據簡化Park分型標準：對稱型25例，偏心型5例，不均衡型3例。結果術中發生1例肋間肌撕裂，術后發生1例胸腔積液、1例肺部感染、1例持續胸背疼痛。手術時間38～89 min，平均60.9 min；術中出血量8～90 mL，平均26.2 mL。住院時間6～12 d，平均7.6 d。患者均獲隨訪，隨訪時間12～39個月，平均25.6個月。心電圖和胸部X線片示心臟壓迫改善，臨床癥狀緩解。隨訪期間無支撐鋼板移位。末次隨訪時，根據Nuss等的標準評估手術效果，獲優27例、良3例、中3 例，優良率達90.9%；年齡 lt; 6歲、6～12歲及 gt; 12歲患者間療效比較，差異均無統計學意義（Z= —1.751，P=0.109）。結論胸腔鏡輔助下Nuss手術矯治漏斗胸具有創傷小、手術操作簡便、術后恢復快等優點，矯形效果滿意，根據患者情況彎制個體化支撐鋼板是獲得滿意矯治效果的保證。

引用本文： 李斌,張建華,茍云久,王志強,王成,宋鐵牛,楊建寶. 胸腔鏡輔助下Nuss手術微創矯治漏斗胸的療效觀察. 中國修復重建外科雜志, 2013, 27(5): 599-602. doi: 10.7507/1002-1892.20130132 復制

1.	Ji Y, Liu W, Chen S, et al. Assessment of psychosocial functioning and its risk factors in children with pectus excavatum. Health Qual Life Outcomes, 2011, 9: 28.
2.	Lester CW. The surgical treatment of funnel chest. Ann Surg, 1946, 123: 1003-1022.
3.	Ravitch MM. The operative treatment of pectus excavatum. Ann Surg, 1949, 129(4): 429-444.
4.	Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
5.	曾騏, 張娜, 陳誠豪, 等. 漏斗胸的分型和微創Nuss手術. 中華外科雜志, 2008, 46(15): 1160-1162.
6.	Ghionzoli M, Brandigi E, Messineo A, et al. Pain and anxiety management in minimally invasive repair of pectus excavatum. Korean J Pain, 2012, 25(4): 267-271.
7.	Nagaso T, Miyamoto J, Kokaji K, et al. Double-bar application decreases postoperative pain after the Nuss procedure. J Thorac Cardiovasc Surg, 2010, 140(1): 39-44.
8.	Stanfill AB, DiSomma N, Henriques SM, et al. Nuss procedure: decrease in bar movement requiring reoperation with primary placement of two bars. J Laparoendosc Adv Surg Tech A, 2012, 22(4): 412-415.
9.	Redlinger RE Jr, Kelly RE Jr, Nuss D, et al. One hundred patients with recurrent pectus excavatum repaired via the minimally invasive Nuss technique—effective in most regardless of initial operative approach. J Pediatr Surg, 2011, 46(6): 1177-1181.
10.	Protopapas AD, Athanasiou T. Peri-operative data on the Nuss procedure in children with pectus excavatum: independent survey of the first 20 years’ data. J Cardiothorac Surg, 2008, 3: 40.
11.	Shin S, Goretsky MJ, Kelly RE Jr, et al. Infectious complications after the Nuss repair in a series of 863 patients. J Pediatr Surg, 2007, 42(1): 87-92.
12.	Castellani C, Schalamon J, Saxena AK, et al. Early complications of the Nuss procedure for pectus excavatum: a prospective study. Pediatr Surg Int, 2008, 24(6): 659-666.
13.	劉吉福, 劉濤, 徐波, 等. 微創外科治療成人漏斗胸療效觀察. 中國修復重建外科雜志, 2012, 26(9): 1084-1087.
14.	Lawson ML, Mellins RB, Tabangin M, et al. Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure. J Pediatr Surg, 2005, 40(1): 174-180.
15.	Aronson DC, Bosgraaf RP, Merz EM, et al. Lung function after the minimal invasive pectus excavatum repair (Nuss procedure). World J Surg, 2007, 31(7): 1518-1522.
16.	Redlinger RE Jr, Wootton A, Kelly RE, et al. Optoelectronic plethysmography demonstrates abrogation of regional chest wall motion dysfunction in patients with pectus excavatum after Nuss repair. J Pediatr Surg, 2012, 47(1): 160-164.
17.	Chen ZG, Amos EB, Luo HH, et al. Comparative pulmonary functional recovery after Nuss and Ravitch procedures for pectus excavatum repair: a meta-analysis. J Cardiothorac Surg, 2012, 7: 101.

1. Ji Y, Liu W, Chen S, et al. Assessment of psychosocial functioning and its risk factors in children with pectus excavatum. Health Qual Life Outcomes, 2011, 9: 28.
2. Lester CW. The surgical treatment of funnel chest. Ann Surg, 1946, 123: 1003-1022.
3. Ravitch MM. The operative treatment of pectus excavatum. Ann Surg, 1949, 129(4): 429-444.
4. Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
5. 曾騏, 張娜, 陳誠豪, 等. 漏斗胸的分型和微創Nuss手術. 中華外科雜志, 2008, 46(15): 1160-1162.
6. Ghionzoli M, Brandigi E, Messineo A, et al. Pain and anxiety management in minimally invasive repair of pectus excavatum. Korean J Pain, 2012, 25(4): 267-271.
7. Nagaso T, Miyamoto J, Kokaji K, et al. Double-bar application decreases postoperative pain after the Nuss procedure. J Thorac Cardiovasc Surg, 2010, 140(1): 39-44.
8. Stanfill AB, DiSomma N, Henriques SM, et al. Nuss procedure: decrease in bar movement requiring reoperation with primary placement of two bars. J Laparoendosc Adv Surg Tech A, 2012, 22(4): 412-415.
9. Redlinger RE Jr, Kelly RE Jr, Nuss D, et al. One hundred patients with recurrent pectus excavatum repaired via the minimally invasive Nuss technique—effective in most regardless of initial operative approach. J Pediatr Surg, 2011, 46(6): 1177-1181.
10. Protopapas AD, Athanasiou T. Peri-operative data on the Nuss procedure in children with pectus excavatum: independent survey of the first 20 years’ data. J Cardiothorac Surg, 2008, 3: 40.
11. Shin S, Goretsky MJ, Kelly RE Jr, et al. Infectious complications after the Nuss repair in a series of 863 patients. J Pediatr Surg, 2007, 42(1): 87-92.
12. Castellani C, Schalamon J, Saxena AK, et al. Early complications of the Nuss procedure for pectus excavatum: a prospective study. Pediatr Surg Int, 2008, 24(6): 659-666.
13. 劉吉福, 劉濤, 徐波, 等. 微創外科治療成人漏斗胸療效觀察. 中國修復重建外科雜志, 2012, 26(9): 1084-1087.
14. Lawson ML, Mellins RB, Tabangin M, et al. Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure. J Pediatr Surg, 2005, 40(1): 174-180.
15. Aronson DC, Bosgraaf RP, Merz EM, et al. Lung function after the minimal invasive pectus excavatum repair (Nuss procedure). World J Surg, 2007, 31(7): 1518-1522.
16. Redlinger RE Jr, Wootton A, Kelly RE, et al. Optoelectronic plethysmography demonstrates abrogation of regional chest wall motion dysfunction in patients with pectus excavatum after Nuss repair. J Pediatr Surg, 2012, 47(1): 160-164.
17. Chen ZG, Amos EB, Luo HH, et al. Comparative pulmonary functional recovery after Nuss and Ravitch procedures for pectus excavatum repair: a meta-analysis. J Cardiothorac Surg, 2012, 7: 101.

《中國修復重建外科雜志》

胸腔鏡輔助下Nuss手術微創矯治漏斗胸的療效觀察

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《中國修復重建外科雜志》

胸腔鏡輔助下Nuss手術微創矯治漏斗胸的療效觀察

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