双支架Nuss手术治疗青少年漏斗胸

目的 探讨使用双支架治疗青少年大范围漏斗胸微创Nuss手术的适应证、可行性和手术方法及效果.方法 31例中男24例,女7例;年龄14～18岁,平均(15.32±3.12)岁.根据Hallar指数均评价为中到重度,凹陷范围为4个肋间以上.选择胸腔镜辅助Nuss手术两点或者多点双支架支撑固定法手术.结果 均采用双支架在胸腔镜辅助下顺利完成Nuss手术.术后住院5～10天,平均(7.48±1.95)天;随访4个月到5年.术中发生出血2例,支架滑动移位和间断疼痛2个月各1例,均治愈.结论 胸腔镜辅助双支架矫正大面积、不对称漏斗胸的Nuss手术对青少年是一种安全、有效的方法.

Abstract：

Objective To investigate the indication, feasibility and technique of minimally invasive nuss procedure with thoracoscope by using double braces in the treatment of wide-scope pectus excavatum repairing in adolescence. Methods 31 patients including 24 boys and 7 girls, suffered from pectus excavtum were corrected by nuss procedure under thoracoscope.The average age was (15.32 ± 3.89)years (ranged, 14 years and 18 years). All cases were moderate to severe degree according to Hallar index with depression scope of 4 ribs or more. A couple of braces of two-point or multipoint fixation for thoracoscopic-assisted nuss procedure were used. Results The procedure was successfully completed under thoracoscopy in all patients. Double braces were utilized in 27 cases, double are bars were required in 4 cases, and multipoint fixations were in 6 patients. The postoperative hospital stay was 5-11 days [average, ( 7.48 ± 1.95 ) days]. The duration of following up was one month to three years. The perioperative complications included intraoperative hemorrhage in 2 patients, bar invertion with displacement in 1, and interrupted pain for two months in 1. All patients recovered after expectant treatment. Conclusion Nuss procedure with double braces for the correction of a large area of asymmetric pectus excavatum under thoracoscopy is safe and effective technique for adolescence.