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目的总结非胸腔镜辅助微创Nuss手术治疗漏斗胸的临床经验。方法 2008年7月至2014年2月济南军区总医院胸外科采用非胸腔镜辅助微创Nuss手术治疗51例漏斗胸患儿,其中男32例、女19例,年龄8.32(2.5~17.0)岁。全组均采用双侧胸壁横行切口,将矫形板由左胸壁经胸骨后穿至右胸壁,翻转矫形板并固定于肋骨完成矫正。结果全组患者畸形均得以矫正,手术时间为30~52(38±9)min。其中1例发生心脏损伤,开胸修补成功后放置支撑钢板。术后发生皮下气肿7例、气胸3例、肺不张3例,经保守治疗后痊愈。术后4个月支撑钢板移位1例,再次手术矫正。随访1~42(21.6±7.6)个月,依据Nuss效果评价标准评价优39例,良9例,中3例。结论非胸腔镜辅助微创Nuss手术矫正小儿漏斗胸的矫形效果确切,并发症少,简便可行,安全有效。
Objective To summarize the clinical experience of non-thoracoscopic assisted minimally invasive Nuss surgery in the treatment of funnel chest. Methods From July 2008 to February 2014, 51 patients with funnel chest were treated by non-thoracoscopic assisted minimally invasive Nuss surgery in the Department of Thoracic Surgery, Jinan Military Region General Hospital, 32 males and 19 females, aged 8.32 years (2.5-17.0 years) . The whole group were used bilateral chest wall transverse incision, the orthopedic plate from the left chest wall through the sternum to the right chest wall, flip the orthopedic plate and fixed to the ribs to complete the correction. Results All the patients were corrected for deformity, the operation time was 30 ~ 52 (38 ± 9) min. One case of cardiac injury, thoracotomy repair plate steel placed after the success. Postoperative subcutaneous emphysema occurred in 7 cases, 3 cases of pneumothorax, atelectasis in 3 cases, cured by conservative treatment. After 4 months of support plate shift in 1 case, again surgery correction. The follow-up ranged from 1 to 42 (21.6 ± 7.6) months. According to Nuss evaluation criteria, 39 were excellent, 9 were good and 3 were middle. Conclusion The non-thoracoscopic assisted minimally invasive Nuss procedure is effective in correcting pediatric funnel chest. The complication is less, simple and feasible, safe and effective.