6岁以下儿童漏斗胸手术治疗的临床分析

发布时间：2017-12-28 04:35

本文关键词：6岁以下儿童漏斗胸手术治疗的临床分析　出处：《重庆医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：通过总结回顾我院6岁以下先天性漏斗胸患儿的外科治疗经验,探讨6岁以下不同畸形程度及分型的漏斗胸患儿的最佳外科治疗方案,提高本病的临床诊治水平,提高患儿术后的恢复情况。材料与方法：搜集重医附属儿童医院胸心外科2005年5月1日～2014年12月31日确诊为先天性漏斗胸并行手术治疗的病例578例,资料完整457例,其中3岁以下行改良胸骨抬举术239例,3-6岁行改良胸骨抬举术例218,3-6岁行NUSS手术100例,另搜集3岁以下对照组患儿50例,3-6岁对照组患儿50例,同时回顾性分析患儿年龄、临床表现、畸形程度,畸形分型,手术方式与术后并发症及术后恢复情况之间的关系。结果：1.3岁以下组共计239人,全部行我院独创改良胸骨抬举术治疗,平均手术时间85.47±27.15分钟,术中出血量2.31±3.45ml,其中有31例出现轻微短期并发症,无严重近期并发症,出院前均已恢复正常,17例出现远期并发症,术后满意率达97.07%。2.3岁以下组术前与正常患儿肺功能对照见TE/TI、V-PF、25/PF中三项低于正常儿童,术后恢复至正常儿童水平,不同F1分型肺功能均恢复良好。3-6岁组术前各项肺功能均差于正常儿童,术后V50及V25仍低于正常儿童,其中改良胸骨抬举术组轻、中、重度畸形组肺功能恢复各组均取得良好成果,Nuss手术组重度畸形组术后肺功能恢复差于与轻度及中度组。3.不同畸形程度的患儿在Nuss手术和改良胸骨抬举术中均取得良好成果,术后评价满意率均达到95%以上,轻度及中度畸形的患儿两种手术效果相当,重度畸形组患儿改良胸骨抬举术效果好于Nuss手术。4.不同畸形形态的患儿在Nuss手术和改良胸骨抬举术中均取得良好成果,在对称型患儿中两组手术效果相当,在部分非对称型患儿中,改良胸骨抬举术优于Nuss手术。结论：1.3岁以下漏斗胸患儿行我院独创改良胸骨抬举术去的良好结果,2.3岁以下术后2年肺功能可完全恢复至正常水平,3-6岁组则仍有小气道通气障碍,Nuss手术组重度漏斗胸肺功能恢复差于轻度及中度组,改良胸骨抬举术不同畸形程度患儿肺功能恢复未见明显差异。3.漏斗胸患儿中,轻中度组患儿的治疗效果,Nuss手术组与改良胸骨抬举术组无明显差异,重度漏斗胸患儿,改良胸骨抬举术组治疗效果优于NUSS手术组。4.3-6岁组漏斗胸患儿中,对称型漏斗胸患儿的治疗效果Nuss手术组与改良胸骨抬举术组无明显差异,非对称型患儿的治疗效果中,偏心型组改良胸骨抬举术优于NUSS手术。5.综上所述,通过本次研究,我们推荐：A、3岁以下漏斗胸患儿有以下2项及以上的建议立即手术治疗：1)CT检查提示Haller指数3.2或者FI0.3；2)反复上呼吸道感染、肺炎、活动量明显少于同龄儿、出现肺不张、潮气肺功能提示限制性通气功能障碍；3)心电图提示IRBBB、ST-T段改变,心脏彩超提示心脏瓣膜脱垂等异常情况；4)畸形程度进展且症状加重的患儿。B、3-6岁患儿：1)有重度漏斗胸、非对称型漏斗胸的患儿建议使用改良胸骨抬举术矫正漏斗胸；2)轻中度漏斗胸合并扁平胸的患儿采用Nuss手术。
[Abstract]:Objective: To summarize the experience of surgical treatment for children with congenital pectus excavatum under the age of 6, and to explore the best surgical treatment plan for children with funnel chest under 6 years old. Materials and methods: thoracic surgery from May 1, 2005 to December 31, 2014 re Affiliated Children's hospital diagnosed as congenital pectus excavatum underwent surgery in 578 cases, 457 cases with complete data, of which 3 years of age underwent modified sternal elevation surgery in 239 cases, 3-6 years old underwent modified sternal elevation surgery patients aged 218,3-6 underwent NUSS surgery in 100 cases, the other collect under the age of 3, the control group were 50 cases, 3-6 years old children with the control group of 50 cases, and retrospective analysis of patient age, clinical manifestation, deformity, deformity type, surgical procedures and postoperative complications and restore the relationship between. Results: under the age of 1.3, a total of 239 people, all for our hospital original modified sternal elevation surgery. The average operation time was 85.47 + 27.15 minutes, the amount of intraoperative bleeding was 2.31 + 3.45ml, of which 31 cases had mild short-term complications, no serious complications, before discharge have been restored to normal, 17 patients had long-term complications after the operation, the satisfaction rate was 97.07%. In the group under 2.3 years old, compared with the normal children's lung function before operation, three cases in TE/TI, V-PF and 25/PF were lower than those in the normal children, and recovered to normal children after operation. The lung function of all F1 groups recovered well. The 3-6 age group the preoperative lung function compared with normal children, postoperative V50 and V25 were lower than the normal children, the modified sternal elevation group, moderate and severe deformity group and pulmonary function recovery were achieved good results, Nuss surgery group severe malformation group after pulmonary function recovery and poor in mild and moderate groups. 3. different deformity children have achieved good results in Nuss surgery and modified sternal elevation surgery, postoperative satisfaction rate reached more than 95%, equivalent to two kinds of surgical effect of mild and moderate deformity in children, severe deformity group with modified sternal elevation surgery is better than Nuss. 4. different deformity children all achieved good results in Nuss surgery and modified sternal elevation, the operation effect of the two groups in symmetric children, some children in non symmetrical, modified sternal elevation surgery is better than Nuss. Conclusion: good results under the age of 1.3 children with pectus excavatum in our hospital for modified sternal elevation to the original, fully restored to normal levels in 2 years following surgery. The pulmonary function after 2.3 years old, the age group of 3-6, there is still a small airway disorder, Nuss surgery group of severe pectus excavatum pulmonary function recovery in mild and moderate group. Pulmonary function in children with modified sternal elevation different deformity recovery showed no significant difference. 3. children with pectus excavatum, mild to moderate group treatment, Nuss group with modified sternal elevation surgery group had no significant difference, severe pectus excavatum, modified sternal elevation surgery treatment group is better than the NUSS group. The 4.3-6 age group in children with pectus excavatum, symmetric pectus excavatum surgery group and Nuss treatment effect of modified sternal elevation surgery group had no significant difference, with asymmetric treatment, modified sternal elevation surgery group is better than that of NUSS type. 5. in summary, through this research, we recommend: A, 3 years old of the following children with pectus excavatum has 2 and above recommended immediate surgery: 1) CT showed that Haller index 3.2 or FI0.3; 2) recurrent upper respiratory tract infection, pneumonia, activity was significantly less than the gestational age, atelectasis, moisture pulmonary function that restrictive ventilation dysfunction; 3) ECG IRBBB, ST-T segment changes, echocardiography revealed heart valve prolapse and other abnormal situations; 4) the degree of deformity and progress of symptoms of children. B, 3-6 years old children were: 1) with severe pectus excavatum, asymmetric pectus excavatum children suggested using modified sternal elevation correction of pectus excavatum; 2) with mild to moderate funnel chest flat chest were treated by Nuss surgery.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R726.5

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