中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2010年
1期
8-11
,共4页
洪春巧%李炘%陶麒麟%郑一鸣%贾兵%陈张根
洪春巧%李炘%陶麒麟%鄭一鳴%賈兵%陳張根
홍춘교%리흔%도기린%정일명%가병%진장근
漏斗胸%胸外科手术%体层摄影术,X线计算机
漏鬥胸%胸外科手術%體層攝影術,X線計算機
루두흉%흉외과수술%체층섭영술,X선계산궤
Pectus excavatum%Thoracic surgical procedures%Tomography X-ray computed
目的 探讨采用CT指数客观评估Nuss手术治疗小儿漏斗胸效果的价值.方法 2005年5月至2009年1月,采用胸腔镜辅助下改良Nuss术治疗115例中重度漏斗胸患儿,将已拔除钢板的30例患儿作为研究对象.采用胸部CT扫描分别测量术前、Nuss术后、拔除钢板后的CT指数,进行对比研究.选取年龄匹配的30例排除胸部畸形的患儿作为对照组.将实验组分为小年龄组(≤10岁)22例及大年龄组(>10岁)8例;对称型组18例及不对称型组12例;中度组(CT指数≤5)18例及重度组(CT指数>5)12例.各组之间进行对比及统计分析.结果 实验组Nuss术后以及拔除钢板后的CT指数与术前进行配对t检验显示差异均具有统计学意义(P<0.001),拔除钢板后CT指数与Nuss术后相比,差异无统计学意义(P=0.472),并且与对照组的2.48±0.24相比,差异无统计学意义(P=0.057).小年龄组与大年龄组Nuss术后及拔钢板后的CT指数与术前相比,差异均有统计学意义(P<0.05),而两组之间相比,差异均无统计学意义(P=0.093,P=0.116).对称型组和不对称型组Nuss术后及拔钢板后的CT指数与术前相比,差异均有统计学意义(P<0.05),而两组之间相比,差异均无统计学意K(P=0.281,P=0.610).中度组和重度组Nuss术后及拔钢板后CT指数与术前相比,差异均有统计学意义(P<0.05),两组之间Nuss术后相比,差异有统计学意义(P<0.05),但拔钢板后差异无统计学意义(P=0.093).结论 CT指数可以客观地评估Nuss术矫治小儿漏斗胸术后乃至拔除钢板后的手术效果.无论年龄、畸形类型及畸形程度,Nuss手术均能取得良好效果.
目的 探討採用CT指數客觀評估Nuss手術治療小兒漏鬥胸效果的價值.方法 2005年5月至2009年1月,採用胸腔鏡輔助下改良Nuss術治療115例中重度漏鬥胸患兒,將已拔除鋼闆的30例患兒作為研究對象.採用胸部CT掃描分彆測量術前、Nuss術後、拔除鋼闆後的CT指數,進行對比研究.選取年齡匹配的30例排除胸部畸形的患兒作為對照組.將實驗組分為小年齡組(≤10歲)22例及大年齡組(>10歲)8例;對稱型組18例及不對稱型組12例;中度組(CT指數≤5)18例及重度組(CT指數>5)12例.各組之間進行對比及統計分析.結果 實驗組Nuss術後以及拔除鋼闆後的CT指數與術前進行配對t檢驗顯示差異均具有統計學意義(P<0.001),拔除鋼闆後CT指數與Nuss術後相比,差異無統計學意義(P=0.472),併且與對照組的2.48±0.24相比,差異無統計學意義(P=0.057).小年齡組與大年齡組Nuss術後及拔鋼闆後的CT指數與術前相比,差異均有統計學意義(P<0.05),而兩組之間相比,差異均無統計學意義(P=0.093,P=0.116).對稱型組和不對稱型組Nuss術後及拔鋼闆後的CT指數與術前相比,差異均有統計學意義(P<0.05),而兩組之間相比,差異均無統計學意K(P=0.281,P=0.610).中度組和重度組Nuss術後及拔鋼闆後CT指數與術前相比,差異均有統計學意義(P<0.05),兩組之間Nuss術後相比,差異有統計學意義(P<0.05),但拔鋼闆後差異無統計學意義(P=0.093).結論 CT指數可以客觀地評估Nuss術矯治小兒漏鬥胸術後迺至拔除鋼闆後的手術效果.無論年齡、畸形類型及畸形程度,Nuss手術均能取得良好效果.
목적 탐토채용CT지수객관평고Nuss수술치료소인루두흉효과적개치.방법 2005년5월지2009년1월,채용흉강경보조하개량Nuss술치료115례중중도루두흉환인,장이발제강판적30례환인작위연구대상.채용흉부CT소묘분별측량술전、Nuss술후、발제강판후적CT지수,진행대비연구.선취년령필배적30례배제흉부기형적환인작위대조조.장실험조분위소년령조(≤10세)22례급대년령조(>10세)8례;대칭형조18례급불대칭형조12례;중도조(CT지수≤5)18례급중도조(CT지수>5)12례.각조지간진행대비급통계분석.결과 실험조Nuss술후이급발제강판후적CT지수여술전진행배대t검험현시차이균구유통계학의의(P<0.001),발제강판후CT지수여Nuss술후상비,차이무통계학의의(P=0.472),병차여대조조적2.48±0.24상비,차이무통계학의의(P=0.057).소년령조여대년령조Nuss술후급발강판후적CT지수여술전상비,차이균유통계학의의(P<0.05),이량조지간상비,차이균무통계학의의(P=0.093,P=0.116).대칭형조화불대칭형조Nuss술후급발강판후적CT지수여술전상비,차이균유통계학의의(P<0.05),이량조지간상비,차이균무통계학의K(P=0.281,P=0.610).중도조화중도조Nuss술후급발강판후CT지수여술전상비,차이균유통계학의의(P<0.05),량조지간Nuss술후상비,차이유통계학의의(P<0.05),단발강판후차이무통계학의의(P=0.093).결론 CT지수가이객관지평고Nuss술교치소인루두흉술후내지발제강판후적수술효과.무론년령、기형류형급기형정도,Nuss수술균능취득량호효과.
Objective To evaluated the results of the Nuss procedure children using computed tomographic index Methods We performed the Nuss procedure in 115 patients between May 2005 and January 2009.Thirty of these patients have the chest bars removal Computed tomographic scans were obtained before、after the Nuss procedure and after the bar removal The three CT indices were then calculated.Computed tomographic scans of 30 age-matched patients without chest deformity were collected as controls.Patients were divided into the younger(<or=10 years of age,n=22) and older (>10 years of age,n=8) groups,symmetric groups(n=18) and asymmetric group(n=12),and groups with mild (n=18) and severe (n=12) deformity using a pre-CTi value of 5 as demarcation.These CT indices were compared and statistically analyzed.Results The mean preoperative CTi in all cases was 5.35±3.03.CTi improved to 2.86±0.42 after NUSS procedure,stabilized at 2.82±0.42 after bar removal.The postoperative and post-bar-removal CTi was significantly less than the preoperative CTi(P<0.001),but not significantly different from each other(P=0.472).The post-bar-removal CTi was not significantly different from that of the control (2.48±0.242,P=0.057).Compu-ted tomographic index of the young group improved from 5.55±3.47 to 2.78±0.42 then to 2.75±0.41,and the older group from 4.81±0.98 to 3.08±0.33 then to 3.03±0.39.The post-operative and post-bar-removal CTi values were not significantly different between the younger and the older groups(P=0.093,P=0.116).CT index of the symmetric group improved from 4.92±1.12 to 2.79±0.43 then to 2.79±0.46,and the asymmetric group from 6.00±4.51 to 2.97±0.43 then to 2.87±0.36.These post-operative and after-bar-removal CTi values were not significantly different respectively (P=0.281,P=0.610).In the group with mild depression,the pre-operative CTi was 4.15±0.52,post-operative CTi was 2.72±0.41,and post-bar-removal CTi was 2.71±0.38.The pre-operative CTi in the group with severe deformity was 7.16±4.13.post-operative CTi was 3.07±0.35,and post-bar-removal CTi was 2.98±0.43.Postoperative CTi values between the severe and mild groups were significantly different(P<0.05),but the postbar removal CTi were not different(P=0.093).Conclusions CT scan could provide objective evaluation of Nuss procedure The post-bar-removal CTi was statically equivalent to that of the control cohort.Cood sternal elevation can be achieved with the Nuss procedure regardless of age,the type and severity of chest depression.
