Department of Pediatric Surgery, Osaka City General Hospital, Osaka 534-0021, Japan.
J Pediatr Surg. 2009 Dec;44(12):2426-30. doi: 10.1016/j.jpedsurg.2009.09.006.
In a few patients, cardiac perforation and aortic injury have occurred during the Nuss procedure for pectus excavatum. The article details a modification of this procedure that enables the prevention of fatal complications.
Our subjects were 22 males and 13 females with pectus excavatum who were aged 8.2 +/- 3.7 years. Their Haller's computed tomography index was 5.2 +/- 1.5. An introducer is inserted into the pleura between the sternum and thymus instead of the thoracic depression under right thoracoscopic guidance. After the introducer reaches the internal cranial position of the left nipple, the thoracoscope is shifted to the left thoracic cavity. The introducer is subsequently guided to the left highest intercostal space under left thoracoscopic guidance.
A single bar was inserted in 34 patients; 2 bars were required in 1 patient. The operating time was 95 +/- 27 minutes and blood loss was 11 +/- 6 g. Cardiac perforation did not occur in any patient.
Our modified technique has certain advantages: (1) the introducer does not rub against the pericardium and heart; (2) the tip of the introducer can be observed at all times with a thoracoscope; (3) the anterior mediastinum between the left and right thoracic cavities is very narrow at the cranial level; (4) the introducer can be accurately directed to the left highest intercostal space; and (5) hemostasis and no injury of the bilateral thoracic organs can be confirmed.
在少数患者中，Nuss 手术治疗漏斗胸时发生了心脏穿孔和主动脉损伤。本文详细介绍了一种该手术的改良方法，可预防致命并发症的发生。
我们的研究对象为 22 名男性和 13 名女性漏斗胸患者，年龄为 8.2 ± 3.7 岁。其 Haller 计算的 CT 指数为 5.2 ± 1.5。在右胸腔镜引导下，将导引器插入胸骨和胸腺之间的胸膜内，而不是胸腔凹陷处。当导引器到达左侧乳头的颅内侧位置时，将胸腔镜移至左侧胸腔。然后在左胸腔镜引导下，将导引器引导至左侧最高肋间。
34 例患者插入了 1 根单杠，1 例患者需要插入 2 根杠。手术时间为 95 ± 27 分钟，失血量为 11 ± 6 g。没有患者发生心脏穿孔。
我们的改良技术具有一定的优势：（1）导引器不会与心包和心脏摩擦；（2）可以始终用胸腔镜观察导引器的尖端；（3）左右胸腔之间的前纵隔在颅侧水平非常狭窄；（4）可以准确地将导引器引导至左侧最高肋间；（5）可以止血且不损伤双侧胸腔器官。
