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目的: 探讨施行胸腔镜辅助漏斗胸Nuss矫正术的改进结果和并发症的预防方法.方法: 参照Nuss所报告的原理,经左侧胸腔镜指导,心电图监测及抬高胸骨下端后穿通胸骨后隧道,进行双三点支撑板固定.回顾总结26例手术与随访结果.结果: 除2例有伴发畸形者外, 24例手术时间40~95(平均52)min;术中出血少于15mL,术后平均住院6d.伴支气管源肺囊肿及肺叶肺气肿1例先行胸腔镜右肺上叶切除,再行漏斗胸矫正.早期并发症胸腔残留气体3例,少量胸腔积液1例, 均自动吸收. 切口红肿1 例(未感染). 随访3~35mo.术前反复感染患儿症状改善最明显.支撑板位置优15例,良4例. 5例已取出支撑板,矫正效果优4例,良1例.结论: 胸腔镜辅助漏斗胸Nuss矫正术创伤小、出血少、恢复快,手术年龄以4~8岁为宜,对称性漏斗胸短期矫正效果可靠.推荐左侧胸腔进镜,术中心电图监测和牵高胸骨,双三点固定支撑板.
OBJECTIVE: To explore the improved results and complications of thoracoscopic assisted funnel thoracotomy (Nuss) correction.Methods: According to the principle reported by Nuss, guided by left thoracoscopy, electrocardiogram (ECG) monitoring and the posterior sternal tunnel , And double-three-point support plate was retrospectively reviewed.The results of operation and follow-up of 26 cases were retrospectively analyzed.Results: Except for 2 cases with concomitant deformity, the operation time of 24 cases was 40-95 (average 52) min, intraoperative bleeding was less than 15mL, The average postoperative hospital stay 6d with bronchogenic pulmonary cysts and lobular emphysema in 1 case prior to the thoracoscopic right lung lobectomy, and then correction of funnel chest in early complications of residual gas in the chest in 3 cases, a small amount of pleural effusion, were 1 case of uninfected incision (uninfected) .All cases were followed up for 3 ~ 35 months.The symptom improvement was most obvious in children with repeated infection before surgery.The location of the support plate was excellent in 15 cases and good in 4 cases.The support plate was removed in 5 cases, the correction effect was excellent 4 Cases, good in 1 cases.Conclusion: Thoracoscopic auxiliary funnel chest Nuss orthopedic surgery less trauma, less bleeding, rapid recovery, the surgical age of 4 to 8 years is appropriate, symmetrical functotomy short-term correction of the effect is reliable.Recommended left chest into the mirror , Intraoperative ECG monitoring and pull the sternal, double three fixed support .