漏斗胸合并先天性心脏病的同期手术治疗

发布时间：2018-11-16 14:00

【摘要】：目的：探讨漏斗胸合并先天性心脏病的同期手术方法及可行性，总结同期手术的治疗经验。方法：回顾性分析我院胸心外科2003年01月01日至2014年01月01日收治的漏斗胸合并先心病同期手术的16例患儿，其中男9例，女7例，年龄4月14天~13岁10月（平均年龄3.52±3.30岁），体重5.5~37.0Kg（平均13.22±7.07Kg），其中房间隔缺损11例，室间隔缺损5例，法洛四联症1例；行改良胸骨抬举术15例，微创NUSS胸廓矫形术1例。同时随机选取体重、手术方式相匹配的16例单纯漏斗胸及16例单纯先心病患儿作为对照。比较各组的手术时间、术后镇痛时间、术后监护时间、术后纵膈引流时间、引流量、术后住院时间、并发症及术后效果。结果：本组16例患儿均治愈出院。术后住院8~18天，平均10.43±2.78天，无1例出现反常呼吸、切口感染等并发症。随访11月~9年，所有患儿的胸部外观满意，其中12例患儿已行钢板取出，均能维持原有胸廓形态。复查彩超心功能正常，无残余分流等并发症。漏斗胸合并先心病患儿与单纯先心病的手术时间、术后监护时间、术后纵膈引流时间、引流量及术后住院时间比较差异均无统计学意义，三组患儿并发症比较无明显差异。结论：漏斗胸合并先天性心脏病的同期治疗并不增加手术的风险、并发症及术后恢复时间，同期手术治疗安全可行；同期手术避免了再次手术的麻醉风险及二次手术带来的困难，，节约医疗费用，减轻了患儿的痛苦；合并先心病的漏斗胸手术方式首选改良胸骨抬举术，尤其是婴幼儿患者。
[Abstract]:Objective: to explore the method and feasibility of simultaneous operation of funnel chest combined with congenital heart disease and summarize the experience of simultaneous operation. Methods: a retrospective analysis was made on 16 children with funnel chest combined with congenital heart disease, including 9 males and 7 females, who were treated in our hospital from January 01, 2003 to January 01, 2014, in which 9 cases were male and 7 cases were female. The age ranged from 14 days to 13 years old (mean age: 3.52 卤3.30 years) and weight of 5.5~37.0Kg (mean 13.22 卤7.07Kg). There were 11 cases of atrial septal defect, 5 cases of ventricular septal defect and 1 case of tetralogy of Fallot. 15 cases underwent modified sternal uplift and 1 case underwent minimally invasive NUSS thoracoplasty. At the same time, 16 cases of simple funnel chest and 16 cases of congenital heart disease were randomly selected as control group. The operation time, postoperative analgesia time, postoperative monitoring time, postoperative mediastinal drainage time, postoperative hospitalization time, postoperative complications and postoperative effect were compared. Results: all 16 cases were cured and discharged. Postoperative hospitalization was 818 days (mean 10.43 卤2.78 days). No complications such as abnormal respiration and incision infection were found. All the patients were followed up for 11 ~ 9 years. The chest appearance of all the patients was satisfactory, 12 of them had been removed with steel plate, and all of them could maintain the original chest shape. The cardiac function of color Doppler ultrasound was normal and no complications such as residual shunt were found. There was no significant difference in operation time, postoperative monitoring time, postoperative mediastinal drainage time, drainage volume and postoperative hospitalization time between children with congenital heart disease and simple congenital heart disease. There was no significant difference in complications among the three groups. Conclusion: the simultaneous treatment of funnel chest with congenital heart disease does not increase the risk of operation, complications and postoperative recovery time, the simultaneous operation is safe and feasible. At the same time, the operation avoids the anaesthesia risk of reoperation and the difficulty brought by the secondary operation, saves the medical cost and alleviates the pain of the children. The first choice of the funnel chest operation with congenital heart disease is modified sternum lifting, especially the infant patients.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R726.5

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