[1]刘吉福,薛文平,徐波,等.微创矫治成人漏斗胸近期临床疗效分析[J].中国微创外科杂志,2009,09(5):418-420.
　Liu Jifu,Xue Wenping,Xu Bo,et al.Early Efficacy of Minimally Invasive Correction of Pectus Excavatum in Adult Patients[J].Chinese Journal of Minimally Invasive Surgery,2009,09(5):418-420.
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微创矫治成人漏斗胸近期临床疗效分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
09
期数:
2009年5期
页码:
418-420
栏目:
出版日期:
2009-08-01

文章信息/Info

Title:
Early Efficacy of Minimally Invasive Correction of Pectus Excavatum in Adult Patients
作者:
刘吉福; 薛文平; 徐波; 赵京; 梁海龙
北京军区总医院胸外科，北京100700
Author(s):
Liu Jifu;  Xue Wenping;  Xu Bo;  et al.
Department of Thoracic Surgery, Military General Hospital of Beijing PLA, Beijing 100700, China
关键词:
成人漏斗胸; 外科治疗; 微创手术
Keywords:
Pectus excavatum; Surgical treatment; Minimally invasive surgery
分类号:
R655
文献标志码:
A
摘要:
目的探讨成人漏斗胸微创矫治的可行性及疗效。方法2006年6月~2008年6月，共治疗23例漏斗胸，年龄18~38岁，（24.1±6.6）岁。未做治疗21例；2例Ravitch手术后复发。Haller指数3.2~7.5，4.38±1.16。Ⅰ型14例，Ⅱ型9例。全麻，仰卧位，选择胸骨凹陷最深处两侧腋中线，分别切口3.0 cm，切开至肌层，自切口向胸廓凹陷方向游离。另选切口用CO2气体致人工气胸，进镜观察。在胸腔镜监视下经右侧切口将引导器穿过纵隔，在对侧相同水平或稍斜行位置切口穿出。成形后，将已制备好的Lorenz支撑板穿过纵隔引出，翻转后右侧置固定片，固定片和支撑板两端分别与肌肉固定。术后拍胸片观察支撑板的位置和胸腔情况。结果22例术中顺利，1例损伤心包和右心耳，扩大切口止血。术后恢复顺利，围术期未发生切口感染和支撑杆移位。术后胸闷憋气的症状缓解；胸廓外形接近于正常，非常满意率87%（20/23）。23例随访3~24个月，平均16个月，均保持良好的矫形效果。结论成人漏斗胸采用微创方法矫治是可行的，可以达到良好的矫形效果。
Abstract:
ObjectiveTo study the feasibility and efficacy of minimally invasive repair for pectus excavatum in adult patients. MethodsA total of 23 patients with pectus excavatum aged 18-38 years (mean 24.1±6.6) were treated in our hospital from June 2006 to June 2008. On admission, 21 of patients had never been treated, and 2 patients were recurrent cases after Ravitch surgery; the Haller index of the cases ranged from 3.2 to 7.5 (mean 4.38±1.16); type I pectus excavatum was diagnosed in 14 of the patients (60.9%) and type II in the other 9 (39.1%). Under general anaesthesia with the patients at supine position, two 3cm incisions were made along the bilateral midaxillary line at the level of the most pronounced sternal depression. Then, a conductor was penetrated into the mediastinum from the right to the left at almost the same level. After establishing artificial pneumothorax by CO2 gas, a pectus bar (Lorenz) was placed through the mediastinum under the guidance of thoracoscopy. Afterwards, a stabilizer was used to fix the bar at the right side. Both the stabilizer and the bar were fixed to the muscle layer. Chest Xray was performed to observe the stabilizer and the bar after the operation. ResultsAmong the cases, the procedure was successfully completed in 22 patients. In the other patient, the pericardium and the right atrial appendage were injured, and we had to enlarge the incision for haemostasis. All of the patients were uneventful after the operation. No incisional infection or bar displacement occurred during the perioperative period. During a mean of 16month followup (range 3-24 months), the symptom of chest distress was significant improved, and the cosmetic results were satisfying in 87% of the patients (20/23).ConclusionsMinimally invasive repair is feasible and effective for adult patients with pectus excavatum.

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更新日期/Last Update: 2013-08-19