Ong Caroline C P, Choo Kelvin, Morreau Philip, Auldist Alex
General Surgery Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
ANZ J Surg. 2005 Jun;75(6):421-4. doi: 10.1111/j.1445-2197.2005.03402.x.
The Nuss procedure is a new minimally invasive repair for pectus excavatum that was first published in 1998. Modifications in technique are constantly evolving to minimize complications, especially bar displacement, which are higher in adolescents and adults. The present study reviews our early experience with this procedure in a much older group of children than previously reported and suggests an alternative method of avoiding bar displacement.
Retrospective chart review was carried out on 78 consecutive patients who underwent the Nuss procedure between December 1999 and January 2004. All patients underwent a uniform technique using bilateral lateral stabilisers and thoracoscopy was not used. Operative details, subjective cosmetic results and complication rates were assessed.
The mean age was 15.4 +/- 3.2 years. Single bars were used in 95%, double bars in 5%. The defect was asymmetrical in 26%. The defect was mild in 7%, moderate in 59% and severe in 34%. The median length of stay was 6.0 days (range 4-11). Total operating time was 58 min (range 35-95). Patient controlled analgesia (morphine) for pain relief was used for 105 h (range 61-169) or 4.4 days; the epidural infusion was stopped 1 day earlier. Cosmetic results were excellent in 80.3%. There was residual asymmetry in 75% of the asymmetrical defects although all were improved. Complications included eight (10%) reoperations for bar displacement. This was related to the learning curve as seven of these occurred in the first 2 years of the series. Removal of the bar has been accomplished in 31 (40%) patients. This was elective in all but four patients (three early removals for pain and one for infection).
The Nuss procedure gives good results even in teenagers. Modification of technique and increased experience has reduced complications. The use of bilateral lateral stabilisers without additional wire fixation is an alternative method to avoid bar displacement.
努斯手术是1998年首次发表的一种治疗漏斗胸的新型微创修复手术。技术上的改进不断发展，以尽量减少并发症，尤其是钢板移位，在青少年和成年人中这种情况更为常见。本研究回顾了我们在一组年龄比以往报道的更大的儿童中进行该手术的早期经验，并提出了一种避免钢板移位的替代方法。
对1999年12月至2004年1月期间连续接受努斯手术的78例患者进行回顾性病历审查。所有患者均采用双侧外侧稳定器的统一技术，未使用胸腔镜。评估手术细节、主观美容效果和并发症发生率。
平均年龄为15.4±3.2岁。95%的患者使用单根钢板，5%使用双根钢板。26%的患者缺损不对称。7%的缺损为轻度，59%为中度，34%为重度。中位住院时间为6.0天（范围4 - 11天）。总手术时间为58分钟（范围35 - 95分钟）。使用患者自控镇痛（吗啡）缓解疼痛的时间为105小时（范围61 - 169小时）或4.4天；硬膜外输注提前1天停止。美容效果优秀的占80.3%。75%的不对称缺损仍有残余不对称，尽管所有缺损均有改善。并发症包括8例（10%）因钢板移位而再次手术。这与学习曲线有关，其中7例发生在该系列的前2年。31例（40%）患者已取出钢板。除4例患者外（3例因疼痛早期取出，1例因感染取出），其余均为选择性取出。
即使在青少年中，努斯手术也能取得良好效果。技术改进和经验增加减少了并发症。使用双侧外侧稳定器而不额外进行钢丝固定是避免钢板移位的一种替代方法。
Zotero 插件