漏斗胸的微创内镜修复术。

Jacobs Jeffrey P, Quintessenza James A, Morell Victor O, Botero Luis M, van Gelder Hugh M, Tchervenkov Christo I

Division of Thoracic and Cardiovascular Surgery, All Children's Hospital/University of South Florida College of Medicine, Cardiac Surgical Associates, 603 Seventh Street South, Suite 450, St. Petersburg, FL 33701, USA.

Eur J Cardiothorac Surg. 2002 May;21(5):869-73. doi: 10.1016/s1010-7940(02)00069-6.

OBJECTIVE

We report our initial 3 years 4 months' single institution experience in 31 consecutive patients with pectus excavatum treated with minimally invasive endoscopic pectus excavatum repair utilizing a modification of the 'Nuss' technique.

METHODS

Under general anesthesia, a curved steel bar is individually shaped for each patient to match the ideal chest wall shape and is placed through an endoscopically created retrosternal tunnel between two bilateral midaxillary line 2-cm incisions. The tunnels initially go along the outside of the rib cage, under the pectoral muscles. At the level of the sternum, these tunnels go retrosternal and communicate with each other. The steel bar is passed with the convexity facing posteriorly, within a protective flat silastic drain. Under endoscopic guidance, the curved steel bar is passed through one tunnel, under the sternum, and out the other tunnel. Once positioned, the bar is turned over, thereby correcting the deformity. An epidural catheter provides perioperative pain relief.

RESULTS

Minimally invasive endoscopic pectus excavatum repair has been performed on 31 patients (age: range 4.4-31.0 years, median 15.0 years, mean 14.5 years). Median hospital length of stay is 4 days (range 3-10 days, mean 4.6 days). Pneumothorax occurred in five patients requiring tube thoracostomy in three. One patient developed delayed bilateral pleural effusions requiring drainage. Two patients developed evidence of sterile seroma formation at the skin incision several months after minimally invasive repair of pectus excavatum. These seromas resolved with non-interventional conservative medical treatment. No other complications occurred.

CONCLUSION

The minimally invasive endoscopic pectus repair is safe and effective and currently our procedure of choice for primary pectus excavatum in all ages. Endoscopic visualization facilitates the safe creation of the retrosternal tunnel. Short-term results have been excellent. Further follow-up will be necessary to determine long-term results.

目的

我们报告了在一家机构连续31例漏斗胸患者中，采用改良“努斯”技术进行微创内镜漏斗胸修复术的最初3年4个月的经验。

方法

在全身麻醉下，为每位患者单独塑形一根弯曲的钢棒，以匹配理想的胸壁形状，并通过在内镜下在两个双侧腋中线2厘米切口之间创建的胸骨后隧道置入。隧道最初沿着肋骨笼外部、胸肌下方走行。在胸骨水平，这些隧道进入胸骨后并相互连通。钢棒在一个保护性的扁平硅橡胶引流管内，凸面朝向后方通过。在内镜引导下，弯曲的钢棒穿过一个隧道，在胸骨下方，然后从另一个隧道穿出。一旦定位，将钢棒翻转，从而纠正畸形。硬膜外导管提供围手术期疼痛缓解。

结果

对31例患者（年龄范围4.4 - 31.0岁，中位数15.0岁，平均14.5岁）进行了微创内镜漏斗胸修复术。中位住院时间为4天（范围3 - 10天，平均4.6天）。5例患者发生气胸，其中3例需要胸腔闭式引流。1例患者出现延迟性双侧胸腔积液需要引流。2例患者在微创漏斗胸修复术后数月，在皮肤切口处出现无菌性血清肿形成的迹象。这些血清肿通过非介入性保守药物治疗得以消退。未发生其他并发症。