摘要目的 总结分析胸腔镜辅助下Nuss术式治疗120例漏斗胸患者的近期疗效及经验教训.方法 运用胸腔镜辅助下的Nuss手术方法和不同的麻醉方式对120例漏斗胸患者进行矫治,包括73例胸部凹陷基本对称的漏斗胸患者及47例不对称患者,其中6例为传统手术方式术后复发患者,1例为Nuss术后复发患者.手术方法:气管插管全麻,选择合适的Nuss矫形钢板制备成弧形或双弧形支架,在双侧腋前线至腋中线间各做一1.5～2.5 cm横切口,胸腔镜监视下自右胸切口将导向穿通器由右侧凹陷边缘刺入胸腔,通过胸骨下陷处越过纵隔至左侧凹陷边缘穿出,再将支撑钢板引出后翻转将凹陷的胸廓撑起,达到预期的形状.结果 120例患者均手术成功,手术平均用时58 min,平均失血量30 ml,无严重手术并发症;103例患者术中植入1根支撑钢板即可较好地纠正凹陷的胸廓,17例严重广泛凹陷的漏斗胸患者植入2～3根支撑钢板后亦取得比较满意的矫形效果;对于不对称性的漏斗胸患者通过调整支架固定点,调整支架形状和局部截骨等方法加以矫治后亦使胸廓畸形得到较好的矫正.结论 胸腔镜辅助下Nuss手术矫治漏斗胸方便快捷,手术创伤小,疗效满意.

abstractsObjective To evaluate the short-term effect and experience of Nnss procedure on 120 cases of patients with pectns excavatum. Methods Thoracoscopy assisted Nuss procedure with different ways of anesthesia were applied to 120 cases of patients with pectns excavatum, including 7 cases of recurrence after traditional surgical procedure(6 cases)and Nuss method(another one). The patients ranged in age from 2.5 to 43 (mean 14.1) years and in Hailer index hem 2.91 to 29. Of the 120, 73 had symmetric and 47 had asymmetric pectns excavatum. The Nuss procedure is performed with general anesthesia and a convex steel bar is inserted under the sternum with thoracoscopy through small bilateral thoracic incisions. The steel bar is inserted with the convexity facing posteriorly, and when it is in position, the bar is turned over, thereby correcting the deformity. Results The operation was successfully accomplished without severe complications in all the 120 cases. The mean operative time was 58 minutes and the mean volume of blood loss was 30ml. 103 patients had one bar inserted while the other 17 cases with more extremely diffuse depression required 2 or even 3 bars to get a satisfactory correction. Such methods as modifications to the fixing paints and the shape of the bar, partial osteotomy, were developed to deal with asymmetric ones. Conclusion The Nuss procedure is a minimnlly invasive technique for correction of pectns excavatum. It can lead to a satisfactory outcome and surgical time is less.