Li Bin, Zhang Jianhua, Guo Yunjiu, Wang Zhiqiang, Wang Cheng, Song Tieniu, Yang Jianbao
Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou Gansu, 730030, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 May;27(5):599-602.
To summarize the effectiveness of Nuss procedure by thoracoscopy for correction of pectus excavatum.
Between September 2009 and January 2012, 33 patients suffering from pectus excavatum underwent Nuss procedure by thoracoscopy. There were 26 males and 7 females, aged from 3 to 22 years (median, 9 years). There was primary operation in 32 cases and reoperation in 1 case after Ravitch procedure. Twenty-four patients had obvious clinical symptoms. The Haller index ranged from 3.3 to 50.1 (mean, 5.6). According to simplified Park classification, 25 cases were classified as symmetric type, 5 as eccentric type, and 3 as unbalanced type.
Intercostal muscle tear occurred in 1 case during operation; pleural effusion, pulmonary infection, and thoracic vertebral pain occurred in 1 case, respectively after operation. The operation time ranged from 38 to 89 minutes (mean, 60.9 minutes). The intraoperative blood loss was 8-90 mL (mean, 26.2 mL). The postoperative hospitalization days were 6-12 days (mean, 7.6 days). All patients were followed up 12-39 months (mean, 25.6 months). Electrocardiogram and chest X-ray film showed that cardiac compression was improved, and symptoms alleviated. At the last follow-up, according to the Nuss standard, the results were excellent in 27 cases, good in 3 cases, and fair in 3 cases, with an excellent and good rate of 90.9%. There was no significant difference in results of effectiveness evaluation among less than 6 years, 6-12 years, and more than 12 years groups (Z= -1.751, P=0.109).
Nuss procedure by thoracoscopy has the advantages of little trauma, simple operation, and fast recovery, so it can obtain satisfactory correction of pectus excavatum.
总结胸腔镜下Nuss手术矫治漏斗胸的疗效。
2009年9月至2012年1月，33例漏斗胸患者接受胸腔镜下Nuss手术。其中男性26例，女性7例，年龄3～22岁（中位年龄9岁）。32例为初次手术，1例为Ravitch手术后再次手术。24例有明显临床症状。Haller指数为3.3～50.1（平均5.6）。按简化Park分类，对称型25例，偏心型5例，不均衡型3例。
术中1例发生肋间肌撕裂；术后分别有1例发生胸腔积液、肺部感染和胸椎疼痛。手术时间38～89分钟（平均60.9分钟）。术中出血量8～90毫升（平均26.2毫升）。术后住院天数6～12天（平均7.6天）。所有患者均获随访12～39个月（平均25.6个月）。心电图及胸部X线片显示心脏压迫改善，症状缓解。末次随访时，按Nuss标准评定，优27例，良3例，可3例，优良率90.9%。小于6岁、6～12岁、大于12岁组疗效评价结果差异无统计学意义（Z = -1.751，P = 0.109）。
胸腔镜下Nuss手术具有创伤小、操作简单、恢复快等优点，可获得满意的漏斗胸矫治效果。
