• 北京軍區(qū)總醫(yī)院 胸外科, 北京 100700;

目的 探討兒童漏斗胸微創(chuàng)手術(shù)矯治后胸廓骨的重塑及臨床療效。 方法 回顧性分析2009 年4 月至2010 年9月北京軍區(qū)總醫(yī)院74 例漏斗胸患者經(jīng)微創(chuàng)手術(shù)矯治的臨床資料，其中男63 例，女11例；年齡（11.90±8.50）歲，＜ 10 歲11 例。74 例患者于全身麻醉下在兩側(cè)腋中線做切口，在電視胸腔鏡下引導(dǎo)穿通器經(jīng)胸骨后創(chuàng)出通道，并抬舉胸骨成形后，再將制備好的支撐板置入胸骨后。術(shù)前和術(shù)后1周行胸部CT、胸廓CT 三維重建，矢狀位以胸椎體中心線為切線位，測量胸骨與胸椎體前緣的距離，并觀察心臟移位恢復(fù)情況和胸廓外形。結(jié)果 74 例均順利完成手術(shù)，無手術(shù)死亡。使用1根矯形板66例（89.19%），使用2 根矯形板8 例（10.81%）。使用1 根矯形板、年齡＜ 10 歲的11 例患者術(shù)后7 d 胸骨柄下端和胸骨體各部位與術(shù)前比較均向前移位3.76 ～ 22.92 mm，11 ～ 17 歲的55 例使用1 根矯形板患者胸骨體中間和下端與術(shù)前比較分別向前移位 2.08 mm和10 . 42 mm，兩者胸骨體下端較術(shù)前向前移位的距離比較差異有統(tǒng)計(jì)學(xué)意義（t=14.24, P ＜ 0.05）。術(shù)后7 d 時(shí)11 ～ 17 歲使用2 根矯形板患者胸骨柄下端和胸骨體各部位與術(shù)前比較向前移位4.19 ～ 15.03 mm。術(shù)后7 d 胸部CT 顯示65 例（87.84%）患者心臟位置恢復(fù)正常；用2 根矯形板患者胸廓外觀優(yōu)于用1 根者。隨訪74 例，隨訪率100%；隨訪時(shí)間6 ～ 23 個(gè)月，患者術(shù)前臨床癥狀消失，胸廓外形飽滿，心臟位置完全恢復(fù)正常。 結(jié)論 兒童漏斗胸微創(chuàng)手術(shù)矯治一次性成形具有良好的重塑性；隨著年齡增加，矯治支撐胸骨的力也需要增加，且療效滿意。

引用本文： 劉吉福,徐波,武珊珊. 微創(chuàng)手術(shù)矯治兒童漏斗胸后胸廓骨重塑與臨床療效. 中國胸心血管外科臨床雜志, 2012, 19(1): 39-42. doi: 復(fù)制

1. minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33（4）：545-552.
2. ?2 Nagasao T, Miyamoto J, Tamaki T, et al. Stress distribution on the thorax after the Nuss procedure for pectus excavatum results in.
3. different patterns between adult and child patients. J Thorac.
4. Cardiovasc Surg， 2007, 134（6）：1502-1507.
5. ?3 Kelly RE, Goretsky MJ, Obermeyer R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg, 2010, 252（6）：1072-1081.
6. ?4 曾騏, 彭蕓, 賀延儒, 等. Nuss手術(shù)治療小兒漏斗胸（附60例報(bào)告）. 中華胸心血管外科雜志， 2004， 20（4 ）：223-225.
7. ?5 劉吉福, 薛文平, 徐波,等.微創(chuàng)矯治成人漏斗胸近期臨床療效分析. 中國微創(chuàng)外科雜志, 2009, 9（5 ）：418-420.
8. ?6 魯亞南, 劉錦紛, 徐志偉, 等. 改良Nuss手術(shù)糾治小兒漏斗胸. 中國胸心血管外科臨床雜志, 2007, 14（2）：93-96.
9. ?7 Nakagawa Y, Uemura S, Nakaoka T, et al. Evaluation of the Nuss procedure using pre-and postoperation computed tomographic index. J Pediatr Surg, 2008, 43（3）：518-521.
10. ?8 Coln E, Carrasco J, Coln D. Demonstrating relief of cardiac.
11. compression with the Nuss minimally invasive repair for pectus.
12. excavatum. J Pediatr Surg, 2006, 41 （4）： 683-686.
13. ?9 Nagasao T, Noguchi M, Miyamoto J, et al. Dynamic effects of the Nuss procedure on the spine in asymmetric pectus excavatum. J Thorac Cardiovasc Surg, 2010, 140（6）：1294-1299.
14. forces on the thoracic cage of patients with pectus excavatum after the Nuss procedure. Clin Biomech （Bristol,Avon）, 2008, 23（7）：881-885.
15. procedure in children with pectus excavatum： independent survey of the first 20 years’ data. J Cardiothorac Surg, 2008, 3（1）：40.
16. picture, preoperative evaluation and criteria for operation. Semin Pediatr Surg, 2008, 17（3）：181-193.
17. correction of pectus excavatum in adults patients. J Thorac.
18. Cardiovasc Surg, 2006, 132（3）：524-529.
19. decrease postoperative pain after the Nuss procedure. J Thorac.
20. Cardiovasc Surg, 2010, 140（1）：39-44.
21. Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a.
22. Chang PY, Hsu ZY, Chen DP, et al. Preliminary analysis of the.
23. Protopapas AD, Athanasiou T. Peri-operative data on the Nuss.
24. Kelly RE Jr. Pectus excavatum： historical background, clinical.
25. Mavanur A, Hight DW. Pectus excavatum and carinatum： new concepts in the correction of congenital chest wall deformities in the pediatric age group. Conn Med, 2008, 72（1）：5-11.
26. Pilegaard HK, Licht PB. Routine use of minimally invasive surgery for pectus excavatum in adults. Ann Thorac Surg, 2008, 86（3）：952-956.
27. Schalamon J, Pokall S, Windhaber J, et al. Minimally invasive.
28. Olbrecht VA, Abdullah F, Arnold MA, et al. Upper sternal depression following Lorenz bar repair of pectus excavatum. Pediatr Surg Int, 2008, 24（7）：843-846.
29. Nagaso T, Miyamoto J, Kokaji K, et al. Double-bar application.
  1. 1. minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33（4）：545-552.
  2. 2. ?2 Nagasao T, Miyamoto J, Tamaki T, et al. Stress distribution on the thorax after the Nuss procedure for pectus excavatum results in.
  3. 3. different patterns between adult and child patients. J Thorac.
  4. 4. Cardiovasc Surg， 2007, 134（6）：1502-1507.
  5. 5. ?3 Kelly RE, Goretsky MJ, Obermeyer R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg, 2010, 252（6）：1072-1081.
  6. 6. ?4 曾騏, 彭蕓, 賀延儒, 等. Nuss手術(shù)治療小兒漏斗胸（附60例報(bào)告）. 中華胸心血管外科雜志， 2004， 20（4 ）：223-225.
  7. 7. ?5 劉吉福, 薛文平, 徐波,等.微創(chuàng)矯治成人漏斗胸近期臨床療效分析. 中國微創(chuàng)外科雜志, 2009, 9（5 ）：418-420.
  8. 8. ?6 魯亞南, 劉錦紛, 徐志偉, 等. 改良Nuss手術(shù)糾治小兒漏斗胸. 中國胸心血管外科臨床雜志, 2007, 14（2）：93-96.
  9. 9. ?7 Nakagawa Y, Uemura S, Nakaoka T, et al. Evaluation of the Nuss procedure using pre-and postoperation computed tomographic index. J Pediatr Surg, 2008, 43（3）：518-521.
  10. 10. ?8 Coln E, Carrasco J, Coln D. Demonstrating relief of cardiac.
  11. 11. compression with the Nuss minimally invasive repair for pectus.
  12. 12. excavatum. J Pediatr Surg, 2006, 41 （4）： 683-686.
  13. 13. ?9 Nagasao T, Noguchi M, Miyamoto J, et al. Dynamic effects of the Nuss procedure on the spine in asymmetric pectus excavatum. J Thorac Cardiovasc Surg, 2010, 140（6）：1294-1299.
  14. 14. forces on the thoracic cage of patients with pectus excavatum after the Nuss procedure. Clin Biomech （Bristol,Avon）, 2008, 23（7）：881-885.
  15. 15. procedure in children with pectus excavatum： independent survey of the first 20 years’ data. J Cardiothorac Surg, 2008, 3（1）：40.
  16. 16. picture, preoperative evaluation and criteria for operation. Semin Pediatr Surg, 2008, 17（3）：181-193.
  17. 17. correction of pectus excavatum in adults patients. J Thorac.
  18. 18. Cardiovasc Surg, 2006, 132（3）：524-529.
  19. 19. decrease postoperative pain after the Nuss procedure. J Thorac.
  20. 20. Cardiovasc Surg, 2010, 140（1）：39-44.
  21. 21. Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a.
  22. 22. Chang PY, Hsu ZY, Chen DP, et al. Preliminary analysis of the.
  23. 23. Protopapas AD, Athanasiou T. Peri-operative data on the Nuss.
  24. 24. Kelly RE Jr. Pectus excavatum： historical background, clinical.
  25. 25. Mavanur A, Hight DW. Pectus excavatum and carinatum： new concepts in the correction of congenital chest wall deformities in the pediatric age group. Conn Med, 2008, 72（1）：5-11.
  26. 26. Pilegaard HK, Licht PB. Routine use of minimally invasive surgery for pectus excavatum in adults. Ann Thorac Surg, 2008, 86（3）：952-956.
  27. 27. Schalamon J, Pokall S, Windhaber J, et al. Minimally invasive.
  28. 28. Olbrecht VA, Abdullah F, Arnold MA, et al. Upper sternal depression following Lorenz bar repair of pectus excavatum. Pediatr Surg Int, 2008, 24（7）：843-846.
  29. 29. Nagaso T, Miyamoto J, Kokaji K, et al. Double-bar application.