非胸腔镜剑突下小切口与胸腔镜辅助Nuss手术治疗漏斗胸的临床观察

doi:10.3969/j.issn.1009-976X.2020.06.016

摘要/Abstract

摘要： 目的探讨非胸腔镜剑突下小切口（剑突组）与胸腔镜辅助（胸腔镜组）Nuss手术治疗漏斗胸的不同及优势。方法 2016年至2019年我科收治漏斗胸手术患者59例,平均年龄16±3.82岁,33例行非胸腔镜剑突下小切口Nuss手术,26例行胸腔镜辅助Nuss手术,比较年龄、Haller指数、手术时间,出血量,术后出院时间等。结果两组患者均获得满意效果,剑突组与胸腔镜组在年龄,Haller指数、手术时间,出血量上均无统计学差异,而剑突组出院时间短于胸腔镜镜组。术后6 h至术后24 h,疼痛感明显增强,而术后48 h疼痛则减轻,而术后24 h剑突组疼痛感较胸腔镜轻,有统计学意义。剑突组术后胸腔积液（33.3%）发生率高于胸腔镜组（15.4%）,而剑突组气胸（27.3%）发生率则低于胸腔镜组（42.3%）。胸腔镜组一例非对称性漏斗胸术后2周出现心包积液,双侧大量胸腔积液,治疗后康复出院,其余患者均平稳。结论针对对称性漏斗胸患者,非胸腔镜剑突下小切口与胸腔镜辅助Nuss手术,手术时间、出血量等均无明显差异,均可获得满意效果,而针对非对称或复杂漏斗胸,剑突下小切口安全性则更有保证。

关键词: 胸腔镜, 剑突, 非胸腔镜, 漏斗胸, Nuss手术

Abstract: Objective To investigate the differences and advantages of Nuss surgery in the treatment of pectus excavatum by non thoracoscopic subaxiphoid incision （xiphoid group） and thoracoscopic assisted （thoracoscopic group）. Methods From 2016 to 2019, 59 patients with pectus excavatum were treated in our department, with an average age of 16 ± 3.82 years old. 33 patients underwent non thoracoscopic small incision Nuss operation, and 26 patients underwent thoracoscopic assisted Nuss surgery. The age, Haller index, operation time, blood loss and postoperative discharge time were compared. Results Satisfactory results were obtained in both groups. There were no significant differences in age, Haller index, operation time and blood loss between xiphoid process group and thoracoscopic group, but the discharge time of xiphoid process group was shorter than VATS group. The pain was significantly increased from 6 h to 24 h, after operation, while the pain was alleviated 48 h after operation, while the pain in the 24 xiphoid group was lighter than that in thoracoscopy, which was statistically significant. The incidence of postoperative pleural effusion in xiphoid group （33.3%） was higher than VATS group （15.4%）, while the incidence of pneumothorax in xiphoid group （27.3%） was lower than VATS group （42.3%）. In VATS group, pericardial effusion occurred 2 weeks after operation, and a large number of bilateral pleural effusion occurred. After treatment, the rest of the patients recovered smoothly. Conclusion For patients with symmetrical pectus excavatum, there is no significant difference between non thoracoscopic subaxiphoid incision and thoracoscopic assisted Nuss surgery in terms of operation time and blood loss, which can obtain satisfactory results. However, for asymmetric or complex pectus excavatum, the safety of small incision under xiphoid process is more guaranteed.

Key words: pectus excavatum, xiphoid, non thoracoscopic, vats, Nuss operation

中图分类号:

R655

沈涛, 卢珠明, 段楚骁, 张东熙, 叶敏, 林志潮. 非胸腔镜剑突下小切口与胸腔镜辅助Nuss手术治疗漏斗胸的临床观察[J]. 岭南现代临床外科, 2020, 20(06): 762-765.

SHEN Tao, LU Zhu-ming, DUAN Chu-xiao, ZHANG Dong-xi, YE Min, LIN Zhi-chao. Comparative study of non thoracoscopic subaxiphoid small incision and thoracoscopic assisted Nuss surgery in the treatment of pectus excavatum[J]. Lingnan Modern Clinics in Surgery, 2020, 20(06): 762-765.

参考文献

[1] Nuss D, Kelly RE, Croitoru DP, et al.A 10-year review of a minimally invasive technique for the correction of pectus excavatum[J]. J Pediatr Surg, 1998, 33(4): 545-552.
[2] 王文林, 龙伟光, 陈春梅. Wang手术用于低龄漏斗胸治疗[J]. 南方医科大学学报, 2019, 39(2): 249-252.
[3] Peter SDS, Sharp SW, Ostlie DJ, et al.Use of a subxiphoid incision for pectus bar placement in the repair of pectus excavatum[J]. J Pediatr Surg, 2010, 45(6): 1361-1364.
[4] 崔亚洲, 翟波, 王鹏高, 等. 胸腔镜辅助在先天性漏斗胸患者中的矫形效果分析[J]. 安徽医学, 2018, 39(1): 92-94.
[5] 曾骐, 张娜, 范茂槐, 等. Nuss手术与改良Ravitch手术的对比研究[J]. 中华小儿外科杂志, 2005, 26(8): 397-400.
[6] Hicks CL, von Baeyer CL, Spafford PA, et al. The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement[J]. Pain, 2001, 93(2): 173-183.
[7] Pilegaard H, Licht PB.Minimal Invasive Repair of Pectus Excavatum and Carinatum. Thorac Surg Clin, 2017, 27(2): 123-131.
[8] Irfaan A, Ewais MM, Joseph M, et al.Pectus Excavatum: A Review of Diagnosis and Current Treatment Options[J]. J Am Osteopath Assoc, 2017, 117(2): 106-113.
[9] Engum S, Rescorla F, West K, et al. Is the grass greener? Early results of the Nuss procedure [J]. J Pediatr Surg, 2000, 35(2): 246-251; discussion 257-258.
[10] Umuroglu T, Bostanc K, Thomas DT, et al.Perioperative anesthetic and surgical complications of the Nuss procedure[J]. J Cardiothorac Vasc Anesth, 2013, 27(3): 436-440.
[11] Zhang DK, Tang JM, Ben XS, et al.Surgical correction of 639 pectus excavatum cases via the Nuss procedure[J]. J Thorac Dis, 2015, 7(9): 1595-605.
[12] Nuss D, Croitoru DP, Kelly RE Jr, et al.Review and discussion of the complications of minimally invasive pectus excavatum repair[J]. Eur J Pediatr Surg, 2002, 12(4): 230-234.
[13] Kelly RE Jr, Mellins RB, Shamberger RC, et al.Multicenter study of pectus excavatum, final report: complications, static/exercise pulmonary function, and anatomic outcomes[J]. J Am Coll Surg, 2013, 217(6): 1080-1089.
[14] Jo WM, Choi YH, Sohn YS, et al.Surgical treatment for pectus excavatum[J]. J Korean Med Sci, 2003, 18(3): 360-364.
[15] Bouchard S, Hong AR, Gilchrist BF, Kuenzler KA.Catastrophic cardiac injuries encountered during the minimally invasive repair of pectus excavatum[J]. Semin Pediatr Surg, 2009, 18(2): 66-72.
[16] Kabbaj R, Burnier M, Kohler R, et al.Minimally invasive repair of pectus excavatum using the Nuss technique in children and adolescents: indications, outcomes, and limitations[J]. Orthop Traumatol Surg Res, 2014, 100(6): 625-630.
[17] ErŞen E, Demirkaya A, KiliÇ B, et al. Minimally invasive repair of pectus excavatum (MIRPE) in adults: is it a proper choice?[J]. Wideochir Inne Tech Maloinwazyjne, 2016, 11(2): 98-104.