胸腔镜辅助下Nuss手术微创矫治漏斗胸的疗效观察_《中国修复重建外科杂志》

作者：

李斌 , 张建华 , 苟云久 , 王志强 , 王成 , 宋铁牛 , 杨建宝

兰州大学第二医院胸外科（兰州，730030）;

关键词：

漏斗胸 Nuss手术胸腔镜

DOI：

10.7507/1002-1892.20130132

视频：

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目的总结胸腔镜辅助下Nuss手术微创矫治漏斗胸的临床疗效。方法2009年9月－2012年1 月，于胸腔镜辅助下行Nuss手术微创矫治33例漏斗胸。男26例，女7例；年龄3～22岁，中位年龄9岁。其中1例为Ravitch术后3年复发，余均为初次手术。24例有明显临床症状。Haller指数为3.3～50.1，平均5.6。漏斗胸根据简化Park分型标准：对称型25例，偏心型5例，不均衡型3例。结果术中发生1例肋间肌撕裂，术后发生1例胸腔积液、1例肺部感染、1例持续胸背疼痛。手术时间38～89 min，平均60.9 min；术中出血量8～90 mL，平均26.2 mL。住院时间6～12 d，平均7.6 d。患者均获随访，随访时间12～39个月，平均25.6个月。心电图和胸部X线片示心脏压迫改善，临床症状缓解。随访期间无支撑钢板移位。末次随访时，根据Nuss等的标准评估手术效果，获优27例、良3例、中3 例，优良率达90.9%；年龄 lt; 6岁、6～12岁及 gt; 12岁患者间疗效比较，差异均无统计学意义（Z= —1.751，P=0.109）。结论胸腔镜辅助下Nuss手术矫治漏斗胸具有创伤小、手术操作简便、术后恢复快等优点，矫形效果满意，根据患者情况弯制个体化支撑钢板是获得满意矫治效果的保证。

引用本文： 李斌,张建华,苟云久,王志强,王成,宋铁牛,杨建宝. 胸腔镜辅助下Nuss手术微创矫治漏斗胸的疗效观察. 中国修复重建外科杂志, 2013, 27(5): 599-602. doi: 10.7507/1002-1892.20130132 复制

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.	曾骐, 张娜, 陈诚豪, 等. 漏斗胸的分型和微创Nuss手术. 中华外科杂志, 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.	刘吉福, 刘涛, 徐波, 等. 微创外科治疗成人漏斗胸疗效观察. 中国修复重建外科杂志, 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. 曾骐, 张娜, 陈诚豪, 等. 漏斗胸的分型和微创Nuss手术. 中华外科杂志, 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. 刘吉福, 刘涛, 徐波, 等. 微创外科治疗成人漏斗胸疗效观察. 中国修复重建外科杂志, 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.

《中国修复重建外科杂志》

胸腔镜辅助下Nuss手术微创矫治漏斗胸的疗效观察

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《中国修复重建外科杂志》

胸腔镜辅助下Nuss手术微创矫治漏斗胸的疗效观察

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