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新型微创漏斗胸矫形术临床效果的对比研究

发布时间:2018-06-05 21:20

  本文选题:漏斗胸 + 新型 ; 参考:《新乡医学院》2017年硕士论文


【摘要】:背景漏斗胸是最常见的胸廓畸形,发病率约为0.1-0.3%。目前,手术治疗是最为有效的治疗方式。1998年Nuss[1]提出微创治疗漏斗胸的概念,此后微创手术逐渐取代了传统开胸手术。近年来漏斗胸手术不断得到改良,不断向着更加美观,更加微创的方向发展。在大量Nuss手术的基础上,我们对手术器械及手术方式进行改进并取得专利,于2010年11月开展首例新型微创术式治疗漏斗胸,目前尚未发现此种新型术式与Nuss手术的对比性研究的相关报道。目的探讨新型微创漏斗胸矫形术对于不同年龄组漏斗胸患者治疗的影响,探讨这种新型微创手术的安全性及有效性。通过对比分析新型微创手术与Nuss手术两种不同手术方法的临床资料,研究两种手术方式治疗下,不同年龄组患者漏斗胸指数(Haller指数)的变化、围手术期情况、术后并发症及两种手术方式的手术器械、手术操作的异同,为临床上漏斗胸的手术治疗提供相关参考方案。方法收集我院2010年11月—2016年11月接受新型微创漏斗胸矫形术并已取出矫形板的的患者219例作为实验组,按照年龄将其分为2组:A组为12岁及以下组147例,采用单切口单根矫形板的手术方案(即漏斗胸单孔矫形术);B组为12岁以上组72例。采用置入单根或两根矫形板的手术方案。选取2008年2月—2012年6月接受Nuss手术并已取出矫形板的患儿235例,按照同样的方法分组后设为对照组,通过回顾性对比实验研究,对比分析两种手术方式下不同年龄组患者Haller指数的变化,围手术期情况(包括手术时间、术中出血量、术后住院时间)、术后并发症的发生率及手术效果进行组间对比分析,评定术后的临床疗效。结果实验组和对照组病例全部顺利完成手术。12岁以下年龄组:实验组和对照组术后Haller指数较术前改善明显,差异有统计学意义;矫形板置入后与矫形板取出后Haller指数未出现明显改变,差异无统计学意义;实验组手术时间明显少于对照组,差异有统计学意义;实验组与对照组出血量,术后住院天数、术后并发症发生率、疗效评价差异无统计学意义。12岁以上年龄组:实验组和对照组术后Haller指数较术前改善明显,差异有统计学意义;矫形板置入后与矫形板取出后Haller指数未出现明显改变,差异无统计学意义;实验组手术时间明显少于对照组,差异有统计学意义;实验组与对照组出血量,术后住院天数、术后并发症发生率、疗效评价差异无统计学意义。结论新型微创漏斗胸矫形术与Nuss手术,术后患者的Haller指数较术前均明显得到改善,两种手术方式均可有效治疗不同年龄段的漏斗胸患者。新型微创漏斗胸矫形术与其相比,安全性及有效性无显著性差异,且手术时间明显缩短,操作更加简便,更加微创,是一种安全有效的微创手术方式。
[Abstract]:Background the funnel chest is the most common thoracic malformation with an incidence of 0.1-0.3. At present, surgical treatment is the most effective treatment. In 1998, Nuss [1] put forward the concept of minimally invasive treatment of funnel chest. Since then, minimally invasive surgery has gradually replaced the traditional thoracotomy. In recent years, funnel chest surgery has been continuously improved to a more beautiful, more minimally invasive direction. On the basis of a large number of Nuss operations, we have improved and patented the surgical instruments and methods. In November 2010, we carried out the first new minimally invasive operation to treat funnel chest. At present, there is no report on the comparative study of this new type of operation and Nuss operation. Objective to investigate the effect of new minimally invasive funnel chest orthopedics on patients with funnel chest in different age groups, and to explore the safety and effectiveness of the new minimally invasive surgery. By comparing and analyzing the clinical data of new minimally invasive surgery and Nuss operation, the changes of pectus funnel index (Haller index) and perioperative period of patients with different age groups were studied. The postoperative complications and two kinds of surgical instruments, the similarities and differences of the operation procedures, provide the relevant reference scheme for the clinical operation of funnel chest. Methods from November 2010 to November 2016, 219 patients with new minimally invasive funnel chest orthopedic surgery were selected as experimental group. According to their age, they were divided into two groups: group A, group 12, and group A, with 147 cases under 12 years of age. A single incision and single orthopedic plate was used. 72 cases of group B were over 12 years old. A single orthopedic plate or two orthopedic plates were implanted. From February 2008 to June 2012, 235 children undergoing Nuss operation and having removed the orthopedic plate were divided into two groups as control group according to the same method. The changes of Haller index in different age groups, perioperative period (including operation time, intraoperative bleeding, postoperative hospitalization time, incidence of postoperative complications and operative effect) were compared and analyzed. To evaluate the clinical effect after operation. Results all the patients in the experimental group and the control group had successfully completed the operation. The Haller index in the experimental group and the control group was significantly improved after operation compared with that before operation, and the difference was statistically significant. There was no significant change in Haller index after orthopedic plate placement and orthopedic plate removal, the difference was not statistically significant; the operative time in the experimental group was significantly shorter than that in the control group, and the difference was statistically significant. There was no significant difference in the incidence of postoperative complications and the evaluation of curative effect. The Haller index in the experimental group and the control group was significantly improved compared with that in the pre-operation group, and the difference was statistically significant. There was no significant change in Haller index after orthopedic plate placement and orthopedic plate removal, the difference was not statistically significant; the operative time in the experimental group was significantly shorter than that in the control group, and the difference was statistically significant. There was no significant difference in the incidence of postoperative complications and the evaluation of curative effect. Conclusion the Haller index of patients with new minimally invasive orthopedic funnel chest surgery and Nuss operation were improved significantly compared with those before operation. The two surgical methods can effectively treat patients with funnel chest in different ages. Compared with the new minimally invasive orthopedic operation of funnel chest, there is no significant difference in safety and effectiveness, and the operation time is obviously shortened, the operation is more simple and minimally invasive, and it is a safe and effective minimally invasive operation method.
【学位授予单位】:新乡医学院
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R655

【参考文献】

相关期刊论文 前10条

1 曹睿;王强;吴勇;万来忆;曾光;徐文举;彭寿行;肖明第;;漏斗胸单孔矫形术203例临床分析[J];中国胸心血管外科临床杂志;2016年12期

2 白洁;闫天生;;Nuss微创手术治疗漏斗胸的现状及进展[J];中国微创外科杂志;2015年08期

3 刘玉;邹志强;杨露;李传海;;非胸腔镜辅助Nuss手术治疗漏斗胸51例分析[J];中国胸心血管外科临床杂志;2015年02期

4 刘文亮;孔德淼;喻风雷;;胸腔镜与非胸腔镜辅助改良Nuss手术矫治漏斗胸的临床比较[J];中南大学学报(医学版);2013年08期

5 刘文亮;喻风雷;尹邦良;;非胸腔镜辅助改良Nuss手术矫治漏斗胸[J];重庆医科大学学报;2011年08期

6 郭卫刚;葛棣;丁建勇;王群;;胸腔镜Nuss术纠治青少年漏斗胸的疗效和安全性分析[J];中国临床医学;2011年04期

7 潘征夏;杨杰先;吴春;李洪波;王刚;李勇刚;;改良胸骨抬举术治疗儿童先天性漏斗胸268例[J];中华胸心血管外科杂志;2007年04期

8 潘征夏;杨杰先;吴春;李洪波;王刚;;胸骨抬举加钢板固定纠治幼儿漏斗胸[J];中华小儿外科杂志;2006年07期

9 胡廷泽;漏斗胸外科治疗:30年406例经验回顾[J];中华小儿外科杂志;2005年08期

10 俞松,胡月光,方勇,刘远梅,金燕,杨小红;漏斗胸手术方式的选择[J];中华小儿外科杂志;2005年08期



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