Department of Cardiothoracic Surgery, Children's Hospital, Zhejiang University School of Medicine, and Zhejiang Key Laboratory for Diagnosis and Treatment of Neonatal Diseases, Hangzhou, 310003, China.
World J Pediatr. 2011 Aug;7(3):257-61. doi: 10.1007/s12519-011-0319-z. Epub 2011 Aug 7.
This study was to investigate the advantages of thoracoscopy-assisted minimally invasive Nuss operation for the treatment of pectus excavatum (PE) in children.
A total of 406 patients with PE (female: 93; male: 313) with an average age of 6.8 years (range: 3.5-17.5 years) were included in this study. Associated diseases included congenital heart disease in 9 patients and congenital pulmonary cyst in 2. The Haller index of the patients ranged from 3.35 to 7.23, with an average of 5.17±1.64. Minimally invasive Nuss operation was performed for all the patients.
The operations were performed successfully and no operative mortality occurred. The average blood loss during the operation was less than 10 mL and the operating time ranged from 30 to 85 minutes with an average of 45 minutes. The length of hospital stay ranged from 5 to 9 days with an average of 7 days. Struts were implanted in 12 (3.0%) of the 406 patients. Injury of the pericardium occurred in 1 patient during the operation. Early post-operative complications occurred in 9 patients with pneumothorax and 6 patients with pleural effusion, which were cured by puncture or drainage. Poor wound healing occurred in 4 patients (1.0%) and was cured by nutritional support. During a 3-month to 6-year follow-up, 2 patients had scoliosis and 3 patients had displacement of the strut, which was cured by a second Nuss operation. Allergy occurred in 2 patients: the symptoms were improved in 1 patient after conservative treatment, but the strut was removed in advance due to allergy in the other patient. Totally 154 patients (40.0%) underwent operation for strut removal. Excellent repair results were achieved in 387 (95.3%) patients, good repair results in 12 (3.0%), and fair results in 7 (1.7%).
Thoracoscopy-assisted Nuss operation has many advantages including small and masked incision, short operative time, minimal blood loss, fast recovery, less trauma, and satisfactory outcomes of repair. Nuss is a safe and reliable technique for repair of PE.
本研究旨在探讨胸腔镜辅助微创 Nuss 手术治疗儿童漏斗胸（PE）的优势。
本研究共纳入 406 例 PE 患者（女性 93 例，男性 313 例），平均年龄 6.8 岁（3.5-17.5 岁）。合并疾病包括 9 例先天性心脏病和 2 例先天性肺囊肿。患者的 Haller 指数为 3.35-7.23，平均为 5.17±1.64。所有患者均行微创 Nuss 手术。
手术均顺利完成，无手术死亡。术中平均出血量少于 10ml，手术时间 30-85 分钟，平均 45 分钟。住院时间 5-9 天，平均 7 天。406 例患者中 12 例（3.0%）植入支架。1 例患者术中出现心包损伤。9 例患者术后早期出现气胸，6 例患者出现胸腔积液，经穿刺或引流治愈。4 例（1.0%）患者伤口愈合不良，经营养支持治愈。3 个月至 6 年随访中，2 例患者出现脊柱侧弯，3 例患者支架移位，再次行 Nuss 手术治愈。2 例患者发生过敏：1 例经保守治疗后症状改善，另 1 例因过敏提前取出支架。共 154 例（40.0%）患者行支架取出术。387 例（95.3%）患者修复效果优良，12 例（3.0%）良好，7 例（1.7%）一般。
胸腔镜辅助 Nuss 手术具有切口小、隐蔽、手术时间短、出血量少、恢复快、创伤小、修复效果满意等优点。Nuss 技术是治疗 PE 的一种安全可靠的方法。
