摘要
目的探讨漏斗胸Nuss术后钢板取出手术的改进方法。方法2008年1月～2011年2月64例漏斗胸Nuss术后钢板取出，27例为双侧切口，其中双侧固定片18例、单侧固定片9例，包括2例肋骨骨痂包绕成骨、2例严重漏斗胸；37例为单侧切口。采用单腔气管插管全麻，平卧位，选固定片侧原手术侧切口，将固定片外露出皮肤后去除，再使用骨科旋转器将钢板向外稍扳直后，向下沿着钢板弧度将钢板拉出。结果手术时间10-75min，平均21min；术中出血量5—450ml，平均为15ml。2例（3．1％）术中出血量〉400ml，为钢板固定片骨痂形成，术中损伤肋间血管导致出血；1例（1．6％）钢丝遗留再次手术去除；4例（6．2％）术后少量气胸，2例（3．1％）术后术口感染，保守治疗后痊愈。术后住院时间1—13d，平均2．5d。术后1年取出钢板2例（3．1％），术后2年3例（4．7％），术后3年59例（92．2％）。2年内拆除钢板原因为患者对钢板过敏致钢板外露（4例）和钢板严重移位（1例）。64例随访4～36个月，平均16．8月，所有患者均保持同术前相近的良好漏斗胸畸形矫正效果。结论漏斗胸Nuss手术患者钢板多在3年后去除，通过改良Nuss术后钢板取出手术方法，采用固定片侧原手术侧切口，将固定片外露出皮肤后先去除，然后将钢板向外稍扳直后沿钢板弧度不翻转钢板向下将钢板顺原位取出，可以减少和预防并发症发生。
Objective To explore the modified procedures for removing Nuss bar.Methods From January 2008 to February 2011,64 patients with pectus excavatum who had recieved Nuss operation,had their pectus bar removed in our hospital.In the patients,27 cases had bilateral incisions(metallic stabilizers have been used on both sides in 18 patients,and single side in the other 9 patients including 2 patients with almost complete neo-ossification of the Nuss bar and 2 patients with severe pectus excavatum);the other 37 patients had unilateral incision.Under genreal anesthesia with single-luman tracheal tube,with the patient lying down in supine position,the bar was pulled out along the thoracic wall through the original incision.Results The mean operation time for bar removal was 21 minutes(10-75 min),and the mean intraopeartive blood loss was 15 ml(5-450 ml).Two patients(3.1%) had hemorrahge > 400 ml because of porosis around the bar or injury to the intercostal vessels;one patient(1.6%) recieved a second operation due to residual bar;four patients(6.2%) developed mild peumothorax and two patients(3.1%) showed incisional infection after the operation,these patients were cured by conservative therapies.The patients were discharged from hospital in 1 to 13 days(mean 2.5 days) after the surgery.Two of them(3.1%) had the bar removed in one year,three(4.7%) in two years,and 59(92.2%) in three years.The causes of removing the bar in two years included rejection to(4 cases),and relocation of the bar(1 case).The patients were followed up for 4 to 36 months with a mean of 16.8 months.All the patients had the cosmetic outcomes of the Nuss operation maintained.Conclusions Nuss bar is usually removed in three years postoperation.With modified procedures,through the original surgical incisoin,after pulling out and removing the metallic stabilizers,we suggest straighten the bar outward and then pull out the bar along the incision without turning it over so that to avoid complications.
出处
《中国微创外科杂志》
CSCD
2011年第7期625-629,共5页
Chinese Journal of Minimally Invasive Surgery
