Shu-li Liu, Wen-ya Wang, Zhen Chen, Jun Zhang, Chen Wang, Long Li, Wen-xiao Wang, Xu Li, Kao-ping Guan, Guo-liang Qiao, Zhen Zhang, Jun-Tto Ge, Jin-shan Zhang, Yan-dong Wei, Wei Cheng
Department of Pediatric Surgery, Capital Institute of Pediatrics, Yabao Road 2#, Chaoyang, Beijing, 100021, China.
Pediatr Surg Int. 2015 Jul;31(7):627-31. doi: 10.1007/s00383-015-3706-z. Epub 2015 Apr 18.
To compare total extra-pleura Nuss procedure with classical Nuss, and evaluate the efficacies and safety of thoracoscopic total extra-pleural approach of Nuss procedure for correction of pectus excavatum in children.
We managed 69 patients with pectus excavatum from July 2006 to October 2012. Of the 69 patients, 40 underwent thoracoscopic total extra-pleural approach of Nuss (group A), and 29 underwent classical Nuss procedure (group B). In group A, there were 29 boys and 11 girls, and the mean age was 6.4 (ranged from 3.5 to 14.5). Under thoracoscopic guidance, an extra-pleural tunnel was created using a blunt dissector via a right thoracic incision. A steel bar was inserted in the entirely extra-pleural tunnel. The bar was turned and fixed as in standard Nuss procedure. In group B, there were 20 boys and 9 girls, and the mean age was 5.9 (ranged from 4 to 11) years. Under thoracoscopic guidance, a blunt dissector was inserted into pleura cavity directly via a right thoracic incision. It was a standard Nuss procedure.
The operations were completed successfully in all patients. None of the children developed pneumothorax or injuries to the pericardium, heart or lungs. The operating time was 42.0 ± 5.3 and 43.4 ± 6.0 min in group A and B, respectively, and the difference was not significant (p = 0.306). Compared to group B, the postoperative hospital stay of group A was shorter (4.0 ± 1.1 vs 5.2 ± 1.2 days, p = 0.001). The outcomes of both groups were similar (97.5% in group A vs 93.8% in group B, p = 0.377) but pain time was shorter, and time of taking painkiller was less than those of group B (2.6 ± 0.8 vs 4.1 ± 1.0 days, p = 0.001; 1.1 ± 0.6 vs 1.8 ± 0.9 time, p = 0.008). No patients in group A developed subcutaneous emphysema or pleural irritation, while 5 patients in group B showed the symptoms (p = 0.004). All patients were followed-up for 4-30 months (mean 20.2). During the follow-up, none of the children had pulmonary infection or dislocation of the steel board or fixation instruments before the bar was removed. 69 patients removed their bar after a 24-month period on average. According to Nuss' postoperative assessment criteria, one patient in group B was fair. The other patients were all excellent or good.
Extra-pleura Nuss procedure under thoracoscopic guidance is a safe and less traumatic procedure for the correction of pectus excavatum. It is not only superior in postoperative recovery and pleural cavity protection, but also results in fewer complications than the intrapleural procedures.
比较完全胸膜外Nuss手术与传统Nuss手术，评估胸腔镜下完全胸膜外Nuss手术治疗小儿漏斗胸的疗效及安全性。
2006年7月至2012年10月，我们收治了69例漏斗胸患者。其中，40例行胸腔镜下完全胸膜外Nuss手术（A组），29例行传统Nuss手术（B组）。A组中，男29例，女11例，平均年龄6.4岁（3.5～14.5岁）。在胸腔镜引导下，经右胸切口用钝性剥离器建立胸膜外隧道。将一根钢板插入完全位于胸膜外的隧道内。如标准Nuss手术一样翻转并固定钢板。B组中，男20例，女9例，平均年龄5.9岁（4～11岁）。在胸腔镜引导下，经右胸切口直接将钝性剥离器插入胸膜腔。这是标准的Nuss手术。
所有患者手术均成功完成。所有患儿均未发生气胸或心包、心脏及肺部损伤。A组和B组手术时间分别为42.0±5.3分钟和43.4±6.0分钟，差异无统计学意义（p = 0.306）。与B组相比，A组术后住院时间更短（4.0±1.1天 vs 5.2±1.2天，p = 0.001）。两组疗效相似（A组97.5% vs B组93.8%，p = 0.377），但A组疼痛时间更短，使用止痛药的时间也少于B组（2.6±0.8天 vs 4.1±1.0天，p = 0.001；1.1±0.6次 vs 1.8±0.9次，p = 0.008）。A组无患者发生皮下气肿或胸膜刺激症状，而B组有5例出现该症状（p = 0.004）。所有患者均随访4～30个月（平均20.2个月）。随访期间，所有患儿在钢板取出前均未发生肺部感染、钢板或固定器械移位情况。69例患者平均24个月后取出钢板。根据Nuss术后评估标准，B组1例患者疗效为一般。其他患者均为优秀或良好。
胸腔镜引导下胸膜外Nuss手术治疗漏斗胸安全、创伤小。不仅术后恢复及胸膜腔保护方面更具优势且并发症少于胸膜内手术。
