CAJ | 학술논문

目的：探讨两侧胸壁纵切口改良Nuss手术在漏斗胸患者中的应用技巧和疗效。方法：对我院2006年8月-2014年4月收治的240例漏斗胸患者采用两侧胸壁纵切口改良Nuss手术矫治，根据Park分型，对称性164例，非对称性76例。术前CT检查Haller指数：3.3～16.5（平均5.1±1.9）。所有患者均采用气管插管吸入+静脉复合麻醉，采用胸腔镜辅助下两侧胸壁纵切口改良Nuss手术矫治，均未放置胸腔引流管。结果：240例患者均顺利完成手术，手术时间30～90min，平均（45．56±13．48）min。术中因横行放置钢板塑形不佳而改为跨肋间斜行放置15例，因极重度漏斗胸而行双侧胸腔镜序贯监视10例，术中未发生心脏、肺、膈肌穿通伤等严重并发症。术中出血量少，小于20mL。术后发现创周皮下气肿20例，少量气胸6例，胸腔积液4例，均保守治疗改善。出院后随访1～48个月，未发生因钢板移位、翻转而导致的伤害性事件。早期随访3个月，240例患者中，212例（占88.3%）获得优秀的塑形治疗效果，28例（占11.7%）获得良好的塑形效果，无塑形效果差者。术后中、后期，发生切口钢板过敏反应10例。136例于术后24～40个月左右行内支撑钢板取出术，轻度复发6例，未见中、重度复发。结论：两侧胸壁纵切口改良Nuss手术效果良好，简化了经典Nuss手术过程，值得推广。
목적：탐토량측흉벽종절구개량Nuss수술재루두흉환자중적응용기교화료효。방법：대아원2006년8월-2014년4월수치적240례루두흉환자채용량측흉벽종절구개량Nuss수술교치，근거Park분형，대칭성164례，비대칭성76례。술전CT검사Haller지수：3.3～16.5（평균5.1±1.9）。소유환자균채용기관삽관흡입+정맥복합마취，채용흉강경보조하량측흉벽종절구개량Nuss수술교치，균미방치흉강인류관。결과：240례환자균순리완성수술，수술시간30～90min，평균（45．56±13．48）min。술중인횡행방치강판소형불가이개위과륵간사행방치15례，인겁중도루두흉이행쌍측흉강경서관감시10례，술중미발생심장、폐、격기천통상등엄중병발증。술중출혈량소，소우20mL。술후발현창주피하기종20례，소량기흉6례，흉강적액4례，균보수치료개선。출원후수방1～48개월，미발생인강판이위、번전이도치적상해성사건。조기수방3개월，240례환자중，212례（점88.3%）획득우수적소형치료효과，28례（점11.7%）획득량호적소형효과，무소형효과차자。술후중、후기，발생절구강판과민반응10례。136례우술후24～40개월좌우행내지탱강판취출술，경도복발6례，미견중、중도복발。결론：량측흉벽종절구개량Nuss수술효과량호，간화료경전Nuss수술과정，치득추엄。
Objective: To explore the surgical skills and efifcacy of the modiifed Nuss procedure on pectus excavatum repair with bilateral chest wall vertical incisions.Methods: Two hundred forty patients (181 male, 59 female, aged 2.5-25 years with an average of 8.0 ±5.1 years) with pectus excavatum undergone the modiifed Nuss procedure in our hospital between August 2006 and April 2014 were recruited in this study. One hundred and sixty-four out of 240 patients were symmetry and 76 were asymmetry according to the Park’s classiifcation. Preoperative Haller Index (HI) of the patients was determined by computed tomography (CT) and ranged from 3.3 to 16.5 with an average of 5.1±1.9. All patients were anesthetized by combined tracheal in intubation and intravenous anesthesia, underwent the modiifed Nuss procedure assisted by thoracoscopy, and not used of pleu-ral drainage tubes.Results:The surgery of all patients went smoothly, and the operating time ranged from 30 to 90 minutes with an average of (45.56±13.48) minutes. The plates were changed to diagonal placement because of the ineffective repairs of the lateral placement in 15 cases. Sequential biventricular thoracoscopy for bilateral chest wall were applied in 10 cases due to extremely severe pectus excavatum. Severe complications, such as penetrating injuries on heart, lung and diaphragm, didn’t occurred and the amount of bleeding was little (less than 20 ml) during the operation. 20, 6, and 4 patients showed subcutaneous emphysema, little pneumothorax, and pleural effusion after operation, respectively. All complications relieved after conservative therapy. Post-dis-charge follow-up time was 1-48 months. During the early 3 months follow-up period, 212 of 240 cases (88.3%) showed excellent molding effects while 28 cases (11.7%) attained good molding effects. And no bad corrective results happened. In the middle to late after operation, 10 incision allergic reactions of the plates occurred. The buttress plates of 136 patients were removed during the period of 24-40 months after operation and 6 showed slightly recurrence.Conclusion: The modiifed Nuss procedure with vertical incisions on bilateral chest walls simpliifes the processes of the classical Nuss procedure, and is worth of being generalized.