Xin Pengge,Mou Yaru,Ding Yiming,et al.Efficacy of double-bar versus single-bar Nuss surgery for pectus excavatum in children aged 13-18:a comparative study[J].Journal of Clinical Pediatric Surgery,2025,(04):356-361.[doi:10.3760/cma.j.cn101785-202410053-010]
胸腔镜下双钢板与单钢板Nuss手术治疗13至18岁漏斗胸患者的疗效对比研究
- Title:
- Efficacy of double-bar versus single-bar Nuss surgery for pectus excavatum in children aged 13-18:a comparative study
- Keywords:
- Funnel Chest; Adolescent; Surgical Procedures; Operative; Nuss surgery; Methods; Video-assisted Thoracic Surgery; Treatment Outcome; Comparative Study
- 摘要:
- 目的 总结胸腔镜下双钢板Nuss手术治疗13至18岁漏斗胸患者的可行性与手术经验,并比较其与单钢板Nuss手术的疗效差异。方法 回顾性分析山东大学齐鲁医院小儿外科2019年1月至2023年9月行胸腔镜下双钢板Nuss手术矫形的66例13至18岁漏斗胸患者临床资料(为双钢板组),并与本院2014年1月至2018年12月期间行单钢板Nuss手术的62例13至18岁漏斗胸患者(为单钢板组)进行对比,统计两组患者手术时间、术中出血量、术后疼痛时间、住院时间、治疗效果、钢板移位发生率以及并发症情况,分析两种术式的疗效差异。结果 两组128例患者均顺利完成手术。与单钢板组相比,双钢板组手术时间延长,术后疼痛时间缩短,钢板移位发生率降低,疗效优秀率更高,差异均有统计学意义(P＜0.05);两组术中出血量、术后住院时间、术后发热时间及总体并发症发生率比较,差异均无统计学意义(P＞0.05)。结论 胸腔镜下双钢板Nuss手术治疗13至18岁漏斗胸患者安全、有效,较单钢板Nuss手术,有术后疼痛时间短、钢板移位发生率低、疗效更好等优势,值得在临床推广。
- Abstract:
- Objective To summarize the feasibility and surgical experience of double-bar Nuss surgery for pectus excavatum (PE) in elder children aged 13-18 years and compare the differential efficacy with single-bar Nuss surgery.Methods The relevant clinical data were retrospectively reviewed for 66 PE children undergoing double-bar Nuss surgery from January 2019 to September 2023 and 62 elder PE children undergoing single-bar Nuss surgery from January 2014 to December 2018.The perioperative and follow-up data of two groups were statistically analyzed,and the differences in the efficacy of the two types of surgery were summarized and analyzed.Results All operations were completed successfully.As compared with single-bar group,operative duration became prolonged in double-bar group,postoperative pain time was shortened,the incidence of bar displacement declined and excellent rate of postoperative efficacy evaluation improved.No significant inter-group differences existed in intraoperative volume of blood loss,postoperative hospital stay,postoperative fever time or overall complication rate.Conclusions As compared with single-bar counter-part,double-bar method offers the advantages of shorter postoperative pain time,lower plate displacement rate and better postoperative efficacy evaluation.It is worthy of wider clinical promotion.
参考文献/References:
[1] Torre M,Guerriero V,Wong MCY,et al.Complications and tren-ds in minimally invasive repair of pectus excavatum:a large volume,single institution experience[J].J Pediatr Surg,2021,56(10):1846-1851.DOI:10.1016/j.jpedsurg.2020.11.027.
[2] Haecker FM,Hebra A,Ferro MM.Pectus bar removal-why,when,where and how[J].J Pediatr Surg,2021,56(3):540-544.DOI:10.1016/j.jpedsurg.2020.11.001.
[3] Kim DH,Hwang JJ,Lee MK,et al.Analysis of the Nuss procedure for pectus excavatum in different age groups[J].Ann Thorac Surg,2005,80(3):1073-1077.DOI:10.1016/j.athoracsur.2005.03.070.
[4] Yu SP,Lai PS,Pan CT,et al.Comparison of several alternatives for the management of severe pectus excavatum in the Nuss procedure[J].Asian J Surg,2021,44(5):738-741.DOI:10.1016/j.asjsur.2020.12.039.
[5] Liu SM,Wang L,Zhang HK,et al.Modified Nuss procedure with a novel steel bar in patients with pectus excavatum post-congenital heart surgery[J].Interact Cardiovasc Thorac Surg,2022,34(3):424-430.DOI:10.1093/icvts/ivab284.
[6] Han JC,Mou YR,Wang DM,et al.Modified bar bending method of thoracoscopic Nuss procedure on pectus excavatum:a retrospective single-center study[J].BMC Pediatr,2023,23(1):109.DOI:10.1186/s12887-023-03909-2.
[7] 万丽,赵晴,陈军,等.疼痛评估量表应用的中国专家共识(2020版)[J].中华疼痛学杂志,2020,16(3):177-187.DOI:10.3760/cma.j.cn101379-20190915-00075. Wan L,Zhao Q,Chen J,et al.Expert consensus on the application of pain evaluation questionnaires in China (2020)[J].Chin J Painol,2020,16(3):177-187.DOI:10.3760/cma.j.cn101379-20190915-00075.
[8] Kloth K,Klohs S,Bhullar J,et al.The epidemiology behind pectus excavatum:clinical study and review of the literature[J].Eur J Pediatr Surg,2022,32(4):316-320.DOI:10.1055/s-0041-1729898.
[9] 中华医学会小儿外科学分会心胸外科学组,广东省医师协会胸外科分会.漏斗胸外科治疗中国专家共识[J].中华小儿外科杂志,2020,41(1):7-12.DOI:10.3760/cma.j.issn.0253-3006.2020.01.002. Team of Cardiothoracic Surgery,Branch of Pediatric Surgery,Chinese Medical Association; Branch of Thoracic Surgery,Guangdong Provincial Physician Association.National consensus on surgery for pectus excavatum in china[J].Chin J Pediatr Surg,2020,41(1):7-12.DOI:10.3760/cma.j.issn.0253-3006.2020.01.002.
[10] Yoo G,Jeong JY.Nuss procedure for combined pectus excavatum and carinatum in a patient with a history of congenital esophageal atresia repair surgery[J].J Cardiothorac Surg,2022,17(1):4.DOI:10.1186/s13019-022-01759-0.
[11] 严冬,曾骐,陈诚豪,等.桥式连接技术在漏斗胸手术中的应用[J].临床小儿外科杂志,2023,22(8):747-750.DOI:10.3760/cma.j.cn101785-202303003-009. Yan D,Zeng Q,Chen CH,et al.Application of bridge technique for pectus excavatum bar fixation during Nuss procedure[J].DOI:10.3760/cma.j.cn101785-202303003-009.
[12] 卞军,施伟栋.NUSS术中斜行放置钢板矫治大龄儿童漏斗胸23例[J].中华小儿外科杂志,2020,41(9):784-787.DOI:10.3760/cma.j.cn421158-20191015-00591. Bian J,Shi WD.Feasibility of Nuss procedure for correcting pectus excavatum by oblique placement in elder children:a report of 23 cases[J].Chin J Pediatr Surg,2020,41(9):784-787.DOI:10.3760/cma.j.cn421158-20191015-00591.
[13] 阳广贤,易立文,王敬华,等.双钢板NUSS手术矫治大龄儿童极重度漏斗胸[J].临床小儿外科杂志,2017,16(3):242-246.DOI:10.3969/j.issn.1671-6353.2017.03.010. Yang GX,Yi LW,Wang JH,et al.Nuss procedure for correcting extremely severe pectus excavatum by double braces in elder children[J].J Clin Ped Sur,2017,16(3):242-246.DOI:10.3969/j.issn.1671-6353.2017.03.010.
[14] 曾骐,段贤伦,张娜,等.大年龄组漏斗胸的微创Nuss手术[J].中华胸心血管外科杂志,2007,23(3):193-195.DOI:10.3760/cma.j.issn.1001-4497.2007.03.019. Zeng Q,Duan XL,Zhang N,et al.Nuss procedure for the correction of pectus excavatumin elder group[J].Chin J Thorac Cardiovasc Surg,2007,23(3):193-195.DOI:10.3760/cma.j.issn.1001-4497.2007.03.019.
[15] Nagaso T,Miyamoto J,Kokaji K,et al.Double-bar application decreases postoperative pain after the Nuss procedure[J].J Thorac Cardiovasc Surg,2010,140(1):39-44.E2.DOI:10.1016/j.jtcvs.2009.12.027.
[16] Nissen AP,Kilbourne MJ,Jeschke R,et al.Delayed presentation of cardiac perforation after modified Ravitch pectus excavatum repair[J].Ann ThoracSurg,2020,109(1):e29-e31.DOI:10.1016/j.athoracsur.2019.04.103.
[17] Jawitz OK,Raman V,Thibault D,et al.Complications after Ravitch versus Nuss repair of pectus excavatum:a Society of Thoracic Surgeons (STS) General Thoracic Surgery Database analysis[J].Surgery,2021,169(6):1493-1499.DOI:10.1016/j.surg.2020.12.023.
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备注/Memo
收稿日期:2024-10-23。
通讯作者:王健,Email:wjdoctor2021@126.com