CAJ | 학술논문

目的探讨Nuss手术治疗先天性心脏病术后漏斗胸的不同方法,提高手术的安全性.方法 2003年4月到2014年2月,36例先天性心脏病患儿术后漏斗胸于胸腔镜辅助下行Nuss手术,其中男21例,女15例.年龄3～24岁,平均(7.03±4.21)岁.Haller指数3.28～17.70,平均5.07±2.55.所有患儿术前均行心脏超声和CT检查,判断胸骨后的粘连情况.12例行标准三切口全胸腔镜Nuss手术,20例行原小切口辅助Nuss手术,4例行前悬吊的Nuss手术.结果 36例均顺利完成手术,手术时间27～230 min,平均(59.11±37.22)min,出血1～150 ml,平均3.00 ml.随访2周至120个月,术后优良率100％,手术并发症4例,占11.11％.结论只要方法得当,Nuss手术治疗先天性心脏病术后漏斗胸也是安全可行的,标准三切口全胸腔镜Nuss手术和辅助原小切口Nuss手术,可以提高手术的安全性,并能及时发现和处理手术造成的损伤.为了减少不必要的损伤也可以采用前悬吊技术.
목적 탐토Nuss수술치료선천성심장병술후루두흉적불동방법,제고수술적안전성.방법 2003년4월도2014년2월,36례선천성심장병환인술후루두흉우흉강경보조하행Nuss수술,기중남21례,녀15례.년령3～24세,평균(7.03±4.21)세.Haller지수3.28～17.70,평균5.07±2.55.소유환인술전균행심장초성화CT검사,판단흉골후적점련정황.12례행표준삼절구전흉강경Nuss수술,20례행원소절구보조Nuss수술,4례행전현조적Nuss수술.결과 36례균순리완성수술,수술시간27～230 min,평균(59.11±37.22)min,출혈1～150 ml,평균3.00 ml.수방2주지120개월,술후우량솔100％,수술병발증4례,점11.11％.결론 지요방법득당,Nuss수술치료선천성심장병술후루두흉야시안전가행적,표준삼절구전흉강경Nuss수술화보조원소절구Nuss수술,가이제고수술적안전성,병능급시발현화처리수술조성적손상.위료감소불필요적손상야가이채용전현조기술.
Objective To explore the different techniques for Nuss procedure in the treatment of pectus excavatum after repairing congenital heart disease (CHD) and boost its surgical safety.Methods A retrospective study was conducted for 36 cases of pectus excavatum undergoing thoracoscopic Nuss procedure after repairing CHD from April 2003 to February 2014.A total of 2540 patients were recruited,including 21 males and 15 females with combined pectus deformity and CHD.Their average age was 7.03 (3.0 ± 24.0) years and mean Haller index 5.07 (3.28 ± 17.70).All patients were examined for retrosternal adhesions by electrocardiography and chest computed tomography (CT) scan.Results All patients underwent the Nuss procedure successfully with a mean operative duration of 59.1 (27.0±230.0) min and a median blood loss of 3.0 (1.0 ± 150.0) ml.During a follow-up period of 2 weeks to 120 months,the excellent and good rate was 100％.Four cases (11.11％) had perioperative complications.Conclusions Nuss procedure is both safe and effective for pectus excavatum after repairing CHD in children.The standard three-incision and auxiliary original incision thoracoscopic Nuss procedure allow surgeons to monitor and handle intraoperative complications without delay.For greater security,anterior suspension to sternum is recommended.