【摘要】 目的:探讨Nuss手术矫治漏斗胸后应用改良技术取出矫形钢板的可行性及安全性。方法:回顾性总结2008年12月至2012年2月漏斗胸矫形钢板取出患者资料共186例。所有病例仅切开右侧原手术切口(Nuss手术固定片安装在右侧)。全身麻醉,单腔气管插管或喉罩,患者仰卧位,采用改良钢板取出技术,术中矫形钢板无需扳直或翻转。结果:Nuss手术后2年取出钢板132例(71.0%),2年半以上53例(28.5%),1年以内1例(0.5%)。钢板取出手术时间9～20(13.1±3.4)min;术中出血量3～20(5.2±2.7)mL。术后无胸腔内活动性出血,无切口感染;术后右侧少量气胸3例(1.6%)。术后住院时间均为1 d。186例随访4～48(21.4±6.8)个月,漏斗胸复发1例(0.5%)。结论:Nuss手术后2年或更长时间可经单一右侧原切口,采用改良技术取出矫形钢板,不需翻转以及扳直钢板,具有简单、可行、安全的优点。更多还原

【Abstract】 Objective:To evaluate the safety and efficacy of modified technique for removing Nuss bar after Nuss procedure.Methods:We reviewed 186 patients undergoing bar removal after repair of pectus excavatum with Nuss procedure at our institution from December 2008 to February 2012.All patients had unilateral incision(metallic stabilizers have been used on one side in all patients).Under general anesthesia with single lumen tracheal tube or laryngeal mask,with the patient lying down in supine position,the bar was pulled out along the thoracic wall without overturning or straightening.Results:Totally 132 patients(71.0%) had the bar removed 2 years after the Nuss procedure,1(0.5%) removed within 1 year and 53(28.5%) removed over 2 and half years.The operation time for bar removal was 9-20(13.1±3.4) min,and the operative blood loss was 3-20(5.2±2.7) mL.There was no hemorrhage.Three patients(1.6%) developed mild pneumothorax and none showed infection of incision after the operation.All patients were discharged 1 day after the surgery and followed up for 4-48(21.4±6.8) months.Recurrence was found in the one who which had the bar removed within 1 year(0.5%).Conclusion:With modified procedures,Nuss bar can be easily and safely removed 2 years or longer after the Nuss operation.After removing the metallic stabilizer,the bar should be turned and then pulled out along the original surgical incision without bending or turning.更多还原