上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (7): 922-.doi: 10.3969/j.issn.1674-8115.2012.07.021

• 论著（临床研究） • 上一篇    下一篇

改良Nuss手术治疗复发性漏斗胸的疗效分析

肖海波, 梅举, 张辅贤, 李国庆, 钟 竑, 胡丰庆   

  1. 上海交通大学 医学院附属新华医院心胸外科, 上海 200092
  • 出版日期:2012-07-28 发布日期:2012-08-17
  • 作者简介:肖海波（1975—）, 男, 副主任医师, 博士；电子信箱: xnavor@163.com。

Outcomes of modified Nuss procedure in treatment of recurrent pectus excavatum

XIAO Hai-bo, MEI Ju, ZHANG Fu-xian, LI Guo-qing, ZHONG Hong, HU Feng-qing   

  1. Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
  • Online:2012-07-28 Published:2012-08-17

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摘要：

目的 观察辅助剑突下小切口改良Nuss手术治疗复发性漏斗胸的临床效果。方法 2007年7月—2010年8月，对22例复发性漏斗胸需接受二次手术的患者实施辅助剑突下小切口的改良Nuss手术。对患者的初次手术情况及二次手术前症状、Haller指数、手术过程、并发症及术后随访情况进行回顾性分析。以同期接受Nuss手术的51例漏斗胸初次手术患者作为对照组。结果 22例患者初次手术中，Ravitch手术12例、改良Ravitch手术7例，胸骨翻转术3例。术前症状包括活动耐量下降、活动后气急、胸痛、反复呼吸道感染和心悸；平均Haller指数为4.81±0.8；与对照组比较，复发性漏斗胸组手术时间较对照组显著延长（P<0.05），两组术中出血量、术后住院时间和术后并发症（气胸、胸腔积液、持续疼痛和腋下切口感染等）发生率比较，差异均无统计学意义（P>0.05）。两组均无围手术期死亡和心脏损伤病例。随访1~4年，患者术前症状明显减轻或消失，9例患者拆除钢板，未发现钢板或固定片移位。结论 复发性漏斗胸的手术风险较大，辅助剑突下小切口改良Nuss手术的操作安全性高，可有效纠正复发性漏斗胸。

关键词: 漏斗胸, 复发, 二次手术, 微创, Nuss手术

Abstract:

Objective To investigate the outcomes of modified Nuss procedure with a subxiphoid incision in treatment of recurrent pectus excavatum. Methods From July 2007 to August 2010, 22 patients with recurrent pectus excavatum underwent a secondary repair using the modified Nuss procedure with a subxiphoid incision. Conditions of first repair, symptom, Haller index, operation course and complications before second repair, and follow up after second repair were retrospectively analysed. Besides, another 51 patients with pectus excavatum undergoing first Nuss procedure in the same period were served as control group. Results Among the 22 patients with recurrent pectus excavatum, there were 12 cases of Ravitch procedure, 7 cases of modified Ravitch procedure and 3 cases of sterno-turnover procedure in the first repair. The symptoms before the second repair included decreased endurance, dyspnea on exertion, chest pain, frequent respiratory infection and palpitation. The average Haller index was 4.81±0.8. The average duration of reoperation was significantly longer than that of control group (P<0.05). There was no significant difference in volume of blood loss, duration of postoperative hospitalization and prevalence of postoperative complications (pneumothorax, pleural effusion, persistent pain and wound infection in lateral incision) between two groups (P>0.05). There was no case of perioperative death or cardiac perforation in two groups. The patients were followed up for 1 to 4 years, the preoperative symptoms significantly alleviated or disappeared. The steel bars were demolished in 9 patients, and no steel bar malposition and stabilizer displacement was found. Conclusion Although recurrent pectus excavatum repair is technically challenging, the modified Nuss procedure with a subxiphoid incision can be performed safely, and may be an alternative approach in treatment of patients with recurrent pectus excavatum.

Key words: pectus excavatum, recurrence, reoperation, minimally invasive, Nuss procedure