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胸腔镜肋软骨切除术联合 Nuss 手术治疗不对称性漏斗胸。

Thoracoscopic Costal Cartilage Excision Combined with the Nuss Procedure for Patients with Asymmetrical Pectus Excavatum.

机构信息

Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.

出版信息

J Laparoendosc Adv Surg Tech A. 2021 Jan;31(1):95-99. doi: 10.1089/lap.2020.0312. Epub 2020 Nov 23.

Abstract

We performed thoracoscopic costal cartilage excision (TCCE) combined with the Nuss procedure to correct asymmetrical pectus excavatum (PE). We reviewed the efficacy of combined TCCE and Nuss procedure for asymmetric PE. Overall, 8 patients with asymmetrical PE underwent TCCE with the Nuss procedure. The Haller index, asymmetry index, and angle of sternal rotation were calculated using preoperative computed tomography. The procedure was performed using bilateral 2.5-cm incisions at the same level of the deepest chest wall depression. The most depressed three to four costal cartilages were partially resected through a right mini-thoracotomy. Subsequently, one or two titanium bars were implanted and secured with stabilizers. The cosmetic outcome was evaluated on the following four ratings: excellent, good, fair, and failure ( = recurrence). The median age at surgery was 14.5 years (8-20 years). The number of bars was one in 3 cases and two in 5 cases. The preoperative Haller index, asymmetry index, and angle of sternal rotation were 4.3 (3.5-5.9), 1.15 (1.04-1.26), and 21.5° (15°-31°), respectively; 2 patients had scoliosis before the Nuss procedure. Complications included surgical site infection and hemothorax. Median follow-up time was 25.5 months (3-63). Bars were removed in 3 patients, 3 years postoperatively. Cosmetic results were excellent, 4; good, 2; fair, 1; failure, 1. Both patients with scoliosis had poor outcomes (fair, 1; failure, 1). Combined TCCE with Nuss procedure is considered safe and effective for patients with asymmetrical PE. Careful long-term follow-up is required, especially in cases with scoliosis.

摘要

我们采用胸腔镜肋软骨切除术(TCCE)联合 Nuss 手术治疗不对称性漏斗胸(PE)。我们回顾了 TCCE 联合 Nuss 手术治疗不对称性 PE 的疗效。共有 8 例不对称性 PE 患者接受了 TCCE 联合 Nuss 手术。术前 CT 计算胸壁凹陷最深水平的 Haller 指数、不对称指数和胸骨旋转角度。手术采用双侧 2.5cm 切口,位于最深胸壁凹陷的同一水平。通过右小切口部分切除最凹陷的三至四根肋软骨。随后,植入 1 至 2 根钛棒,并使用稳定器固定。美容效果评估采用以下四个等级:优、良、可和失败(=复发)。手术时的中位年龄为 14.5 岁(8-20 岁)。1 例使用 1 根钛棒,5 例使用 2 根钛棒。术前 Haller 指数、不对称指数和胸骨旋转角度分别为 4.3(3.5-5.9)、1.15(1.04-1.26)和 21.5°(15°-31°),2 例在 Nuss 手术前有脊柱侧弯。并发症包括手术部位感染和血胸。中位随访时间为 25.5 个月(3-63 个月)。3 例患者在术后 3 年取出了钛棒。美容效果优 4 例,良 2 例,可 1 例,失败 1 例。2 例脊柱侧弯患者的效果较差(可 1 例,失败 1 例)。TCCE 联合 Nuss 手术治疗不对称性 PE 是安全有效的。需要进行仔细的长期随访,尤其是在有脊柱侧弯的情况下。

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