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目的对比Nuss手术与传统改良Ravitch术治疗先天性漏斗胸(PE)的效果,以提高PE的手术疗效。方法回顾性分析本院2003年1月-2009年8月收治的PE患儿63例。男58例,女5例;年龄3~18岁,中位年龄11.5岁。根据手术方式不同分为Nuss组(24例)和改良Ravitch组(39例)。比较2种术式的手术时间、术中出血量、术后住院时间及术后并发症发生率、矫治效果优良率。结果 63例患儿均顺利完成手术,术后均无心脏大血管、心包损伤等严重致命性并发症。Nuss组手术时间(86.5±7.3)min、术中出血量(25.0±4.1)mL,术后住院天数(6.5±0.3)d,均明显少于Ravitch术[(115.6±6.5)min,(68.2±8.6)mL,(10.0±0.6)d],差异均有统计学意义(Pa<0.001)。Nuss组术后并发症发生率为16.7%,Ravitch组为43.6%(P<0.05)。术后随访6个月~2 a,Nuss组优22例,良好1例,优良率为95.8%;Ravitch组优34例,良好4例,优良率为97.4%;二组优良率比较差异无统计学意义(χ2=0.189,P=0.663)。结论 2种术式治疗PE均能达到满意效果,但Ravitch术式并发症较多,而Nuss术微创、切口美观、符合生理、痛苦少,特别适合对称性PE患儿。
Objective To compare the effect of Nuss surgery and traditional modified Ravitch operation on congenital funnel chest (PE) in order to improve the curative effect of PE. Methods Retrospective analysis of 63 patients with PE in our hospital from January 2003 to August 2009. 58 males and 5 females; aged 3 to 18 years, the median age of 11.5 years. Nuss group (24 cases) and modified Ravitch group (39 cases) were divided according to different surgical methods. The operation time, intraoperative blood loss, postoperative hospital stay and postoperative complications were compared between two kinds of surgical procedures, and the excellent and good results were obtained. Results 63 cases of children were successfully completed surgery, no major cardiac vascular, pericardial injury and other serious fatal complications. The operative time (86.5 ± 7.3) min, intraoperative blood loss (25.0 ± 4.1) mL and postoperative hospital stay (6.5 ± 0.3) days in Nuss group were significantly lower than those in Ravitch [(115.6 ± 6.5) min, (68.2 ± 8.6) mL, (10.0 ± 0.6) d], the difference was statistically significant (Pa <0.001). The incidence of postoperative complications in Nuss group was 16.7% and in Ravitch group 43.6% (P <0.05). The patients in Nuss group were excellent in 22 cases and good in 1 case, the excellent and good rate was 95.8%. The excellent and good rate in Ravitch group was 34 and good in 4, the excellent and good rate was 97.4%. No significant difference was found between the two groups Significance (χ2 = 0.189, P = 0.663). Conclusion Two kinds of surgical treatment of PE can achieve satisfactory results, but Ravitch surgery more complications, and Nuss minimally invasive surgery, incision beautiful, in line with physiology, less pain, especially for symmetrical PE children.