摘要目的 将漏斗胸按对称性进行分型,探讨微创Nuss手术方法的改良,以期扩大手术适应证,改进疗效.方法 回顾分析2002年7月到2007年9月403例采用Nuss手术治疗的漏斗胸患者的临床资料.其中男性299例,女性104例,年龄2岁7个月～32岁,平均(8.0±5.1)岁.根据畸形情况和术中支架设计的实际需要将Park分型简化为对称型、偏心型和不均衡型.对称型采用了传统Nuss手术;非对称性的偏心型和不均衡型分别采用了不同的个性化的钢板设计和手术方法.结果 全组患者对称型占63.9%(257/403),偏心型占11.9%(48/403),不均衡型占24.3%(98/403).所有病例均顺利完成手术,手术时间30～165 min,术中出血量1～80 ml,住院时间4～12 d.术后优良率100%.随访1个月～5年,优良率为97.0%.再手术5例,1例术后支架下滑移位导致复发,4例术后一侧凸起畸形均再手术.术中、术后并发症23例占5.7%.除上述5例外,心包损伤2例,支撑架下滑撕开肋间2例,膈肌损伤2例;术后血胸1例,气胸8例,2例间断疼痛2个月,1例持续性疼痛后导致获得性脊柱侧弯.结论 将漏斗胸按对称性进行分型,并选择不同的手术方法,可以扩大Nuss手术的适应证,获得更好的手术效果.

abstractsObjective To investigate the improvement of the Nnss procedure with the classification of the pectus excavatum by symmetry and extend the indication of the operation for a better outcome. Methods The clinic data of 403 patients who underwent repair of pectus excavaturn by Nnss technique and its modifications from July 2002 to September 2007 were reviewed retrospectively. There were 299 male patients and 104 female patients. The age ranged from 2 years and seven months old to 32 years old, with a mean of (8.0±5.1) years old. The entire group of the CT index ranged from 3. 25 to 51.20, with a mean of (5.0±3.0). According to the morphology of the pectns and practically the bar shaping, Park's classification was simplified to symmetric type, eccentric type, and unbalanced type. The patients of symmetric type were all received original Nnss procedure, and the other two types underwent the procedure using characteristic bar shaping and technical modification. Results Among the 403 patients, 257 patients (63.8% )were symmetric pectas excavatum, and 48 patients (11.9%) were eccentric, other 98 patients (24.3%) were unbalanced type. All the patients underwent the procedure successfully. The total time of the procedure ranged from 30 to 165 min , with a mean of (45.7±12.6) min. Volume of blood loss during the operation ranged from 1 to 80 ml, with a mean of (4. 8±6. 2) ml. The days of hospitalization ranged from 4 to 12 d, with a mean of (7.1±1.0) d. The duration of following up ranged from 1 month to 5 years, and the results of the repair were excellent in 391 patients (97.0%). Five patients received a further operation, including 1 patient of recurrent pectns excavatum caused by bar displacement, 4 patients of protruding sideway. There were 23 patients of complications for an overall complication rate of 5.7%. And the other 18 patients of complications included 2 patients of pericardium perforation, 2 patients of bar displacements caused intercostal dilaceration, 2 patients of diaphragmatic muscle injuries, 1 patient of hemothorax, 8 patients of pneumothoraxs, 2 patients of intermittent pains for 2 months, 1 patient of acoholosis caused by persistent pain. Conclusion To classify the pectns excavatum with symmetry and to choose different ways of procedure can extend the indication of Nnss procedure and receive a better outcome.