CAJ | 학술논문

目的探讨非胸腔镜下微创Nuss术矫正漏斗胸的安全性、有效性和治疗经验.方法 2007年10月至2009年5月,手术治疗48例漏斗胸病儿中男28例,女20例;年龄4～13岁,平均(6.5± 2.1)岁.术前CT示胸廓指数3.76±0.54;其中26例行非胸腔镜下微创Nuss术(非胸腔镜组),22例行胸腔镜辅助下Nuss术(胸腔镜组).结果两组均顺利完成手术,术中均无死亡、大出血及胸腔脏器损伤等严重并发症发生.非胸腔镜下Nuss组无气胸,血胸等并发症,无需放置胸腔闭式引流管.其手术时间、术后入院时间与胸腔镜组比较,差异有统计学意义(P<0.05).非胸腔镜下Nuss组手术时间24～38 min,平均(25.4±2.6)min;住院3～6天,平均(4.5±1.1)天;术中出血量5～10 ml.胸腔镜组手术时间40～60 min,平均(53.5±3.4)min,住院5～8天,平均(7.0±2.2)天;出血量10～15 ml.两组病儿术后均获随访,随访时间至少3个月,平均10.4个月,均无漏斗胸复发.非胸腔镜手术组1例术后2月出现肋骨矫形板移位,再次手术重新放置肋骨矫形板.结论非胸腔镜下Nuss术矫正漏斗胸是安全有效的,与胸腔镜辅助下Nuss术相比创伤更小,恢复更快.
목적 탐토비흉강경하미창Nuss술교정루두흉적안전성、유효성화치료경험.방법 2007년10월지2009년5월,수술치료48례루두흉병인중남28례,녀20례;년령4～13세,평균(6.5± 2.1)세.술전CT시흉곽지수3.76±0.54;기중26례행비흉강경하미창Nuss술(비흉강경조),22례행흉강경보조하Nuss술(흉강경조).결과 량조균순리완성수술,술중균무사망、대출혈급흉강장기손상등엄중병발증발생.비흉강경하Nuss조무기흉,혈흉등병발증,무수방치흉강폐식인류관.기수술시간、술후입원시간여흉강경조비교,차이유통계학의의(P<0.05).비흉강경하Nuss조수술시간24～38 min,평균(25.4±2.6)min;주원3～6천,평균(4.5±1.1)천;술중출혈량5～10 ml.흉강경조수술시간40～60 min,평균(53.5±3.4)min,주원5～8천,평균(7.0±2.2)천;출혈량10～15 ml.량조병인술후균획수방,수방시간지소3개월,평균10.4개월,균무루두흉복발.비흉강경수술조1례술후2월출현륵골교형판이위,재차수술중신방치륵골교형판.결론 비흉강경하Nuss술교정루두흉시안전유효적,여흉강경보조하Nuss술상비창상경소,회복경쾌.
Objective The aim of this study was to evaluate the efficacy and safety of the approach of the Nuss procedure for the correction of pectus excavatum in children without thoracoscopy.Methods From Oct 2007 and May 2009,48 patients with pectus excavatum underwent Nuss procedure.Among them 22 were done under the thoracoscopic guidance,and the other 26 in a non-thoracoscopic way,in which,a bilateral extrapleural tunnel to the edge of sternum was created using a blunt dissection via a bilateral thoracic skin incision.Without introducing the thoracoscopy into the thoracic cavity,a steel bar was inserted in the entirely extrapleural tunnel and turned as the standard Nuss procedure.Results All 48 patients recovered uneventfully.There were no postoperative deaths and serious complications.A single alloy steel bar(23-40 cm)was used in all patients.In the non-video-assisted extrapleural group(n=26),no pneumothorax occurred,the operating time(after anesthesia)ranged from 24～38 minutes[mean(25.4±2.6)mins],blood loss was minimal(range,5-10 ml),and the hospital stay was ranged from 3-6 days[mean(4.5±1.1)days].In the thoracoscopic group(n=22),the corresponding figures were 40 to 60 minutes[mean(53.5±3.4)mins)],10 to 15ml,5-8days[mean(7.0±2.2)days],respectively.No recurrent of the funnel chest occurred during the 3-18 months(median 10.4 monthes)of follow-up.The bar displacement occurred in 1 case 2 months after operation,which was replaced with satisfied result.Conclusion The non-thoracoscopic approach of the Nuss procedure is a safe and less traumatic procedure for the correction of pectus excavatum.