改良单切口非胸腔镜Nuss手术治疗小儿漏斗胸的安全性和有效性
The Safety and Efficacy of the Modified Single Incision Non-thoracoscopic Nuss Procedure for Children With Pectus Excavatum.
作者信息
Song Jishuo, Wang Quan, Pan Zhengxia, Wu Chun, Li Yonggang, Wang Gang, Dai Jiangtao, Xi Linyun, Li Hongbo
机构信息
Department of Day Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
出版信息
Front Pediatr. 2022 Feb 8;10:831617. doi: 10.3389/fped.2022.831617. eCollection 2022.
BACKGROUND
This study described and evaluated the safety and efficacy of a modified single incision non-thoracoscopic Nuss procedure in pectus excavatum (PE) children.
METHODS
PE patients undergoing the non-thoracoscopic Nuss procedure at the Children's Hospital of Chongqing Medical University between January 2017 and December 2020 were retrospectively enrolled. The patients were divided into two groups according to operation procedures: the double incision Nuss (DN) group and the modified single incision Nuss (SN) group. Propensity score matching (PSM) was applied before evaluation of operative and postoperative characteristics to reduce selection bias.
RESULTS
Of the 502 patients included, 261 were enrolled in the DN group, and 241 in the SN group. The operation time [35.0 (30.0-40.0) vs. 50.0 (40.0-55.0) minutes, < 0.001] and postoperative inpatient stay [7.0 (6.0-8.0) vs. 7.0 (7.0-8.0) days, < 0.001] of the patients in the SN group after PSM were significantly shorter than those of the patients in the DN group after PSM. Moreover, median blood loss was significantly less in the SN group after PSM than that in the DN group after PSM [2.0 (1.0-5.0) vs. 5.0 (2.0-5.0) ml, < 0.001]. There were no significant differences in the incidence of complications between the two groups ( > 0.05). Bar removal was performed in 85 patients in the SN group within 24-42 months after surgery. Additionally, the SN group patients had a significantly lower Haller index (HI) after bar removal [2.36 (2.15-2.55) vs. 3.76 (3.18-4.26), < 0.001] compared to the initial HI.
CONCLUSIONS
The modified procedure is safe and effective for children with PE and is worthy of clinical application.
背景
本研究描述并评估了改良单切口非胸腔镜下Nuss手术治疗漏斗胸（PE）患儿的安全性和有效性。
方法
回顾性纳入2017年1月至2020年12月在重庆医科大学附属儿童医院接受非胸腔镜下Nuss手术的PE患者。根据手术方式将患者分为两组：双切口Nuss（DN）组和改良单切口Nuss（SN）组。在评估手术及术后特征前应用倾向评分匹配（PSM）以减少选择偏倚。
结果
纳入的502例患者中，DN组261例，SN组241例。PSM后，SN组患者的手术时间[35.0（30.0 - 40.0）分钟对50.0（40.0 - 55.0）分钟，<0.001]和术后住院时间[7.0（6.0 - 8.0）天对7.0（7.0 - 8.0）天，<0.001]显著短于PSM后的DN组患者。此外，PSM后SN组的术中失血量中位数显著少于DN组[2.0（1.0 - 5.0）毫升对5.0（2.0 - 5.0）毫升，<0.001]。两组并发症发生率无显著差异（>0.05）。SN组85例患者在术后24 - 42个月取出钢板。此外，与初始Haller指数（HI）相比，SN组患者取出钢板后的HI显著更低[2.36（2.15 - 2.55）对3.76（3.18 - 4.26），<0.001]。
结论
改良手术对PE患儿安全有效，值得临床应用。
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