CAJ | 학술논문

目的探讨同期治疗合并先天性心脏病(先心)的漏斗胸及先心术后漏斗胸应用NUSS术的方法及可行性.方法统计我院2006年7月至2010年6月与先心相关的漏斗胸15例,A组8例合并先心的漏斗胸患儿在同期行心脏手术和NUSS术,其中男5例,女3例,年龄4岁～13岁4个月(平均6岁1个月).其中4例行室间隔缺损经胸伞封术,2例行房间隔缺损经胸伞封术,1例在体外循环下行室间隔缺损修补术,1例在体外循环下行右室双腔矫治及室间隔缺损修补术.B组7例均为先心术后的漏斗胸行NUSS术,其中男5例,女2例,先心手术年龄6个月～3岁10个月(平均1岁9个月),NUSS术年龄4岁7个月～8岁(平均6岁2个月),6例为体外循环下室间隔缺损修补术后,1例为体外循环下法乐四联症矫治术后.术后常规放置有心包纵隔和/或胸腔引流管.结果所有患儿手术顺利,A组术后5～14 h拔除气管插管,平均(8.8±2.6)h.B组术后4～8 h拔除气管插管,平均(5.9±1.2)h,48～72 h拔除心包纵隔或胸腔引流管.无手术死亡、大出血及胸腔脏器损伤等并发症.术后检查先心矫治效果良好,肺复张良好.术后两组各出现1例切口延期愈合,经治疗后,均顺利出院.随访6个月～4年效果良好.结论 NUSS术用于治疗先心术后漏斗胸以及同期治疗合并先心的漏斗胸安全可行,可有效降低或避免二次手术的难度及风险.
목적 탐토동기치료합병선천성심장병(선심)적루두흉급선심술후루두흉응용NUSS술적방법급가행성.방법 통계아원2006년7월지2010년6월여선심상관적루두흉15례,A조8례합병선심적루두흉환인재동기행심장수술화NUSS술,기중남5례,녀3례,년령4세～13세4개월(평균6세1개월).기중4례행실간격결손경흉산봉술,2례행방간격결손경흉산봉술,1례재체외순배하행실간격결손수보술,1례재체외순배하행우실쌍강교치급실간격결손수보술.B조7례균위선심술후적루두흉행NUSS술,기중남5례,녀2례,선심수술년령6개월～3세10개월(평균1세9개월),NUSS술년령4세7개월～8세(평균6세2개월),6례위체외순배하실간격결손수보술후,1례위체외순배하법악사련증교치술후.술후상규방치유심포종격화/혹흉강인류관.결과 소유환인수술순리,A조술후5～14 h발제기관삽관,평균(8.8±2.6)h.B조술후4～8 h발제기관삽관,평균(5.9±1.2)h,48～72 h발제심포종격혹흉강인류관.무수술사망、대출혈급흉강장기손상등병발증.술후검사선심교치효과량호,폐복장량호.술후량조각출현1례절구연기유합,경치료후,균순리출원.수방6개월～4년효과량호.결론 NUSS술용우치료선심술후루두흉이급동기치료합병선심적루두흉안전가행,가유효강저혹피면이차수술적난도급풍험.
Objective To investigate the clinical outcomes of combining corrective surgery for congenital heart disease (CHD) and NUSS surgery for pectus excavatum (PE) as one-staged operation. Methods From July 2006 to June 2010, 15 children with CHD associated with PE were recruited in this study, and divided into two groups: group A underwent one-staged and group B with twostaged operation. Group A had 8 patients including 5 males and 3 females, aging from 4 to 13.4 years (mean, 6 years and 1 month). Among the 8 patients, 6 with ventricular septal defect (VSD) and 2with atrial septal defect (ASD) underwent interventional or open repair. After the corrective surgery for their CHD, the 8 patients underwent NUSS procedure for pectus excavatum. The group B had 7patients, including 5 males and 2 females. Among them, 6 had VSD and 1 had tetralogy of fallot (TOF). At the first stage, the patients underwent corrective surgery to repair VSD and TOF under CPB. At the second stage, the patients were performed NUSS surgery to correct PE. Their ages at surgery were 4 years and 7 months to 8 years old (mean, 6 years and 2 months). Results All operations were finished successfully. The endotracheal tube was removed 5 to 14 hours after surgery on Group A patients (mean, 8.75 ± 2.59 h), and 4 to 8 hours on Group B patients (mean, 5.86 ±1. 24 h). The drainage tubes of pericardium, mediastinal or chest were removed 48 to 72 h later after surgery. The patients were followed up for 6 months to 4 years. No surgery-related death, hemorrhage, thoracic organ dysfunction and other severe complications were noted. Delayed wound healing was observed on 1 patient in each group. Others recovered from surgery and were discharged from the hospital. Conclusions It is safe to combine corrective surgery for CHD and NUSS procedure for PE as one stage operation.