Liu Wenliang, Kong Demiao, Yu Fenglei, Yin Bangliang
Department of Thoracic Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2013 Mar;38(3):274-8. doi: 10.3969/j.issn.1672-7347.2013.03.010.
To evaluate the safety and efficacy of modified technique for removing Nuss bar after Nuss procedure.
We reviewed 186 patients undergoing bar removal after repair of pectus excavatum with Nuss procedure at our institution from December 2008 to February 2012. All patients had unilateral incision (metallic stabilizers have been used on one side in all patients). Under general anesthesia with single lumen tracheal tube or laryngeal mask, with the patient lying down in supine position, the bar was pulled out along the thoracic wall without overturning or straightening.
Totally 132 patients (71.0%) had the bar removed 2 years after the Nuss procedure, 1 (0.5%) removed within 1 year and 53 (28.5%) removed over 2 and half years. The operation time for bar removal was 9-20 (13.1 ± 3.4) min, and the operative blood loss was 3-20 (5.2 ± 2.7) mL. There was no hemorrhage. Three patients (1.6%) developed mild pneumothorax and none showed infection of incision after the operation. All patients were discharged 1 day after the surgery and followed up for 4-48 (21.4 ± 6.8) months. Recurrence was found in the one who which had the bar removed within 1 year (0.5%).
With modified procedures, Nuss bar can be easily and safely removed 2 years or longer after the Nuss operation. After removing the metallic stabilizer, the bar should be turned and then pulled out along the original surgical incision without bending or turning.
评估改良技术在鸡胸Nuss术后取出Nuss钢板的安全性和有效性。
回顾性分析2008年12月至2012年2月在我院接受鸡胸Nuss术后钢板取出术的186例患者。所有患者均采用单侧切口（所有患者一侧均使用金属稳定器）。在单腔气管插管或喉罩全身麻醉下，患者仰卧位，将钢板沿胸壁拔出，不翻转或拉直。
132例患者（71.0%）在Nuss术后2年取出钢板，1例（0.5%）在1年内取出，53例（28.5%）在2年半后取出。钢板取出手术时间为9 - 20（13.1±3.4）分钟，术中出血量为3 - 2（5.2±2.7）毫升。无出血情况。3例患者（1.6%）出现轻度气胸，术后无切口感染。所有患者术后1天出院，随访4 - 48（21.4±6.8）个月。1例在1年内取出钢板的患者（0.5%）出现复发。
采用改良手术方法，Nuss术后2年或更长时间可轻松、安全地取出Nuss钢板。取出金属稳定器后，应将钢板旋转，然后沿原手术切口拔出，不弯曲或扭转。
