CAJ | 학술논문

目的在NUSS手术的基础上进一步简化手术操作、改善治疗效果并降低术后并发症.方法回顾性分析我院2010年2月至2011年1月收治的漏斗胸患儿103例,其中男93例,女10例,年龄3～14岁,大面积扁平胸加漏斗胸10例,不对称性漏斗胸11例,包括伴部分鸡胸样隆起不对称性漏斗胸3例,复发性漏斗胸5例,其余为基本对称性漏斗胸.矫形钢板采用由我院自主研发的新型改良漏斗胸矫治钢板,按钢板的厚度及宽度不同又分为大小二种型号,钢板的一端与固定片融合,另一端可与引导头或固定片套接.垫片有多种型号可供选择以适应不同类型漏斗胸类型.患儿平卧位,于双侧腋前线各作一长1.5～2.5 cm的切口,深至肋骨骨膜外,沿肋骨骨膜外间隙向胸骨方向分离至胸廓最高点,该点与胸骨最低点在同一水平线上.于腋中线第8肋间打孔置入胸腔镜作引导.用带引导器的钢板的引导头从右面间隙进入,从最高点肋间进右胸,从胸骨最低点后方穿过纵隔,从左侧最高点肋间穿出胸壁(这2个最高点也与胸骨最低点在同一水平线上),并沿左侧间隙及左切口引出引导器,作胸壁塑形,卸去超微创漏斗胸矫治钢板上的引导头,套接上固定片,螺丝固定后,双侧固定片与胸壁肌肉各固定1针,缝合肌肉、皮下及皮肤.结果 103例均获良好矫形效果,8例大面积扁平胸加漏斗胸按NUSS手术常需用2根钢板,我们仅用了1根新改良型钢板也获得了较好的矫形效果.所有患儿术后均可侧卧位.结论新改良钢板具有不需术中加工、安装及拆卸安全方便、不影响患儿胸壁的生长发育等优点；新改良NUSS手术操作简便,效果良好,患儿术后并发症少,疼痛轻、可侧卧.
목적 재NUSS수술적기출상진일보간화수술조작、개선치료효과병강저술후병발증.방법 회고성분석아원2010년2월지2011년1월수치적루두흉환인103례,기중남93례,녀10례,년령3～14세,대면적편평흉가루두흉10례,불대칭성루두흉11례,포괄반부분계흉양륭기불대칭성루두흉3례,복발성루두흉5례,기여위기본대칭성루두흉.교형강판채용유아원자주연발적신형개량루두흉교치강판,안강판적후도급관도불동우분위대소이충형호,강판적일단여고정편융합,령일단가여인도두혹고정편투접.점편유다충형호가공선택이괄응불동류형루두흉류형.환인평와위,우쌍측액전선각작일장1.5～2.5 cm적절구,심지륵골골막외,연륵골골막외간극향흉골방향분리지흉곽최고점,해점여흉골최저점재동일수평선상.우액중선제8륵간타공치입흉강경작인도.용대인도기적강판적인도두종우면간극진입,종최고점륵간진우흉,종흉골최저점후방천과종격,종좌측최고점륵간천출흉벽(저2개최고점야여흉골최저점재동일수평선상),병연좌측간극급좌절구인출인도기,작흉벽소형,사거초미창루두흉교치강판상적인도두,투접상고정편,라사고정후,쌍측고정편여흉벽기육각고정1침,봉합기육、피하급피부.결과 103례균획량호교형효과,8례대면적편평흉가루두흉안NUSS수술상수용2근강판,아문부용료1근신개량형강판야획득료교호적교형효과.소유환인술후균가측와위.결론 신개량강판구유불수술중가공、안장급탁사안전방편、불영향환인흉벽적생장발육등우점；신개량NUSS수술조작간편,효과량호,환인술후병발증소,동통경、가측와.
Objective To present the improved NUSS procedure for children with funnel chest.Methods From February 2010 to January 2011,103 patients (93 males and 10 females)with funnel chest (Pectus Excavatum) underwent surgery in this institution.They aged from 3 to 14 years.There were 10 cases with large area of flat chest plus funnel chest,11 cases with asymmetrical funnel chest which including 3 cases with partial pectus carinatum like asymmetrical uplift,and 5 cases with recurrent funnel chest.With the help of computer-aided design,we invented the steel bars that had independent intellectual property rights.The steel bars were divided into two types according to their thickness and width.One end of the bar was fused with a stabilizer and the other end connected to an introducer or a stabilizer.There were many different pads choices to match the different types of funnel chest.Patients were placed supine position.Two incisions,with length about 1.5-2.5 cm and deep to the rib periosteum were made along anterior axillary lines on the both sides.Along the outer space of the periosteum,the separation toward the highest point of thoracic chest was made,the highest point and the lowest point of sternum were on the same line.A thoracoscope to guide the bar was inserted through a small incision at the middle axillary line and the 8th intercostal space.The steel bar with an introducer on the head was pushed from the right incision along posterior to the sternum and ribs,anterior to the heart and lungs,and through the highest point of left thoracic chest,ending at the left incision.Then the introducer was removed,and the bar was flipped.The metal plates (stabilizers) were connected on the left end of the bar to support the bar and kept it in place.The stabilizer on either side was secured with sutures.Results Good orthopedic effect was achieved in all patients.One steel bar per patient was used for 8 cases with large area flat chest plus funnel chest,while the NUSS procedure required two steel bars.All patients after surgery could stay lateral positions.Conclusions In this improved NUSS procedure,the steel bars do not need to be processed during surgery,the installation and removal of steel bars are safer,more convenient,and no restrictive to the growth and development of children's chest wall.This procedure has less injury,fewer complications,lighter and shorter postoperative pain.