漏斗胸Nuss术不同年龄组临床疗效的对比研究

发布时间：2018-06-25 03:15

本文选题：漏斗胸 + Nuss术　；参考：《华中科技大学》2013年硕士论文

【摘要】：第一部分不同年龄组漏斗胸Nuss手术及近期临床疗效的对比研究目的：回顾性分析不同年龄组漏斗胸Nuss术围手术期情况及临床疗效，探讨漏斗胸Nuss术的适龄年龄。方法：收集172例漏斗胸患儿行Nuss手术的临床资料（所有患儿均为第一次行胸廓矫治术），分为三个年龄组：A组：3~6岁，包括3岁（n=95），B组：6~12岁，包括6岁、12岁（n=51），C组：12岁以上（n=26）。观察三组患儿围手术期情况，包括手术时间、术中出血量、术后下床时间、术后住院时间、术后疼痛程度（采用Wong-baker面部表情量表评分），，统计各组术后并发症，并评定术后临床疗效（根据Nuss疗效评定标准），进行组间对比分析。结果:172例均顺利完成手术。三组患儿中手术时间，A和B组无统计学差异(P0.05)，但C组较A、B两组明显延长(P0.01)。术中出血量，A组较B、C两组明显减少(P0.01)，B和C组间差异亦有统计学意义（P0.05）。A、B、C组中年龄越大，术后下床时间越晚，Wong-baker疼痛程度评分越高，三组间差异均有显著性统计学意义(P0.01)。A、B、C三组术后并发症发生率依次为11.6%、19.6%、30.8%，A和B组及B和C组间无统计学差异(P0.05)，但A和C组差异有统计学意义（P0.05）。三组的手术优良度依次为97.9%、96.1%、92.3%，差异无统计学意义(P0.05)。结论：1、不同年龄组漏斗胸Nuss术后均能获得较高的手术优良度； 2、年龄越小手术操作越容易，术后疼痛越轻、术后并发症越少； 3、漏斗胸Nuss术的手术年龄可以提前，并且是安全的。第二部分不同年龄组漏斗胸Nuss术术后生活质量及中期疗效的观察目的：观察不同年龄组漏斗胸Nuss术术后生活质量的变化及中期疗效。方法：本研究采用改良M-SSQ版本问卷调查。由于部分患儿年龄小，不能清楚表达自我感受，首先对大龄组（C组）中的患儿本人和父母进行独立问卷调查，并进行相关度的分析，观察父母问卷结果是否可以反映患儿本人手术前后生活质量变化和疗效的可行性。然后选取第一部分172例Nuss术后取出矫形钢板的85例进行患儿父母的问卷调查，其中A组45例，B组25例，C组15例，同时对三个组进行Nuss术后复发率的统计。结果：C组中患儿本人和父母的问卷结果一致，具有统计学意义（Spearman相关系数为0.88，P0.05）。A、B、C三个组中对父母的问卷结果平均总分数依次为50.93±7.35、49.33±8.62、49.50±5.61，采用Kruskal-Wallis秩和检验计算三组间差异无统计学意义(P0.05)。在胸廓畸形对社会活动存在干扰（问题3）的比例中，A、B、C三个组依次为22.2%、68%、86.7%，A与B、C两组分别具有显著性统计学差异（P0.01）；A、B、C三个组Nuss术后复发率依次为4.4%、4.0%、6.7%，组间差异无统计学意义(P0.05)。结论：1、Nuss术后父母的问卷结果可以作为患儿本人的问卷结果； 2、不同年龄组Nuss术钢板取出术后均可获得较好的生活质量。低年龄组手术可减少畸形对患儿心理的负面影响，且没有增加复发率； 3、漏斗胸在3-6岁接受Nuss手术是安全可行的。
[Abstract]:Part one comparative study of Nuss operation and recent clinical efficacy of funnel chest in different age groups
Objective: To retrospectively analyze the perioperative period and clinical efficacy of funnel chest Nuss in different age groups, and to explore the age of Nuss in funnel chest surgery.
Methods: the clinical data of 172 children with funnel chest were collected for Nuss operation (all children were first performed by thoracic orthodontic surgery) and divided into three age groups: group A: 3~6 years old, 3 years old (n=95), B group: 6~12 years old, 12 years (n=51), C group: 12 years old (n=26). The perioperative period of three groups of children, including operation time, intraoperative bleeding, was observed. Volume, postoperative hospital bed time, postoperative hospitalization time, postoperative pain degree (using Wong-baker facial expression scale score), statistical analysis of postoperative complications, and evaluate the postoperative clinical efficacy (according to the evaluation criteria of Nuss effect), the comparative analysis between groups.
Results: the operation time of the 172 cases was successfully completed. There was no significant difference in the operation time between the three groups, A and B group (P0.05), but the group C was significantly longer than A and B two groups (P0.01). The higher the degree score, the difference between the three groups had significant statistical significance (P0.01).A, B, and C three groups were 11.6%, 19.6%, 30.8%, A and B and B and C group had no statistical difference (P0.05), but the A and C group had statistical significance (P0.05). The surgical fineness of the three groups was 97.9%, 96.1%, 92.3%, and the difference was not statistically significant. Meaning (P0.05).
Conclusion: 1. Nuss of funnel chest in different age groups can get a higher degree of operation.
2, the younger the operation, the easier the postoperative pain, the less postoperative complications.
3, the operative age of funnel chest Nuss can be advanced and safe.
The second part is the observation of life quality and mid-term curative effect of funnel chest Nuss after different age groups.
Objective: To observe the quality of life and the medium-term effect of Nuss after pectus excavatum surgery in different age groups.
Methods: a modified M-SSQ version questionnaire was used in this study. Due to the age of some children, they could not express their self feelings clearly. First, we conducted an independent questionnaire survey on the children and their parents in the older group (group C), and analyzed their correlation, and observed whether the results of the parents' questionnaire could reflect the quality of life before and after the operation of the children. The first part of the 172 cases after Nuss removal of orthopedic plate was selected in 85 cases of children's parents, including 45 cases in group A, 25 in group B, 15 in group C, and at the same time, the recurrence rate after Nuss was counted in three groups.
Results: the results of the questionnaire in the C group were consistent with the parents, with statistical significance (Spearman correlation coefficient 0.88, P0.05).A, B, C in the three groups of parents were 50.93 + 7.35,49.33 + 8.62,49.50 + 5.61 respectively, and there was no statistical difference between the three groups using Kruskal-Wallis rank and test (P0.05). In the proportion of social activities (problem 3), the three groups of A, B, and C were 22.2%, 68%, 86.7%, A and B, and C two had significant statistical differences (P0.01); A, B, C three groups were 4.4%, 4%, 6.7%, and there was no significant difference between groups (P0.05).
Conclusion: 1. The parents' questionnaire results after Nuss can be used as the result of the questionnaire.
2, good quality of life can be obtained after removal of Nuss plate in different age groups. Low age group operation can reduce the negative effects of malformation on children's psychology, without increasing the recurrence rate.
3, it is safe and feasible to receive Nuss operation at funnel chest at 3-6 years old.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R655

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