本文關(guān)鍵詞：6歲以下兒童漏斗胸手術(shù)治療的臨床分析　出處：《重慶醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 漏斗胸 改良胸骨抬舉術(shù) Nuss手術(shù) 外科治療

【摘要】：目的：通過總結(jié)回顧我院6歲以下先天性漏斗胸患兒的外科治療經(jīng)驗,探討6歲以下不同畸形程度及分型的漏斗胸患兒的最佳外科治療方案,提高本病的臨床診治水平,提高患兒術(shù)后的恢復(fù)情況。材料與方法：搜集重醫(yī)附屬兒童醫(yī)院胸心外科2005年5月1日～2014年12月31日確診為先天性漏斗胸并行手術(shù)治療的病例578例,資料完整457例,其中3歲以下行改良胸骨抬舉術(shù)239例,3-6歲行改良胸骨抬舉術(shù)例218,3-6歲行NUSS手術(shù)100例,另搜集3歲以下對照組患兒50例,3-6歲對照組患兒50例,同時回顧性分析患兒年齡、臨床表現(xiàn)、畸形程度,畸形分型,手術(shù)方式與術(shù)后并發(fā)癥及術(shù)后恢復(fù)情況之間的關(guān)系。結(jié)果：1.3歲以下組共計239人,全部行我院獨創(chuàng)改良胸骨抬舉術(shù)治療,平均手術(shù)時間85.47±27.15分鐘,術(shù)中出血量2.31±3.45ml,其中有31例出現(xiàn)輕微短期并發(fā)癥,無嚴(yán)重近期并發(fā)癥,出院前均已恢復(fù)正常,17例出現(xiàn)遠(yuǎn)期并發(fā)癥,術(shù)后滿意率達(dá)97.07%。2.3歲以下組術(shù)前與正�；純悍喂δ軐φ找奣E/TI、V-PF、25/PF中三項低于正常兒童,術(shù)后恢復(fù)至正常兒童水平,不同F(xiàn)1分型肺功能均恢復(fù)良好。3-6歲組術(shù)前各項肺功能均差于正常兒童,術(shù)后V50及V25仍低于正常兒童,其中改良胸骨抬舉術(shù)組輕、中、重度畸形組肺功能恢復(fù)各組均取得良好成果,Nuss手術(shù)組重度畸形組術(shù)后肺功能恢復(fù)差于與輕度及中度組。3.不同畸形程度的患兒在Nuss手術(shù)和改良胸骨抬舉術(shù)中均取得良好成果,術(shù)后評價滿意率均達(dá)到95%以上,輕度及中度畸形的患兒兩種手術(shù)效果相當(dāng),重度畸形組患兒改良胸骨抬舉術(shù)效果好于Nuss手術(shù)。4.不同畸形形態(tài)的患兒在Nuss手術(shù)和改良胸骨抬舉術(shù)中均取得良好成果,在對稱型患兒中兩組手術(shù)效果相當(dāng),在部分非對稱型患兒中,改良胸骨抬舉術(shù)優(yōu)于Nuss手術(shù)。結(jié)論：1.3歲以下漏斗胸患兒行我院獨創(chuàng)改良胸骨抬舉術(shù)去的良好結(jié)果,2.3歲以下術(shù)后2年肺功能可完全恢復(fù)至正常水平,3-6歲組則仍有小氣道通氣障礙,Nuss手術(shù)組重度漏斗胸肺功能恢復(fù)差于輕度及中度組,改良胸骨抬舉術(shù)不同畸形程度患兒肺功能恢復(fù)未見明顯差異。3.漏斗胸患兒中,輕中度組患兒的治療效果,Nuss手術(shù)組與改良胸骨抬舉術(shù)組無明顯差異,重度漏斗胸患兒,改良胸骨抬舉術(shù)組治療效果優(yōu)于NUSS手術(shù)組。4.3-6歲組漏斗胸患兒中,對稱型漏斗胸患兒的治療效果Nuss手術(shù)組與改良胸骨抬舉術(shù)組無明顯差異,非對稱型患兒的治療效果中,偏心型組改良胸骨抬舉術(shù)優(yōu)于NUSS手術(shù)。5.綜上所述,通過本次研究,我們推薦：A、3歲以下漏斗胸患兒有以下2項及以上的建議立即手術(shù)治療：1)CT檢查提示Haller指數(shù)3.2或者FI0.3；2)反復(fù)上呼吸道感染、肺炎、活動量明顯少于同齡兒、出現(xiàn)肺不張、潮氣肺功能提示限制性通氣功能障礙；3)心電圖提示IRBBB、ST-T段改變,心臟彩超提示心臟瓣膜脫垂等異常情況；4)畸形程度進(jìn)展且癥狀加重的患兒。B、3-6歲患兒：1)有重度漏斗胸、非對稱型漏斗胸的患兒建議使用改良胸骨抬舉術(shù)矯正漏斗胸；2)輕中度漏斗胸合并扁平胸的患兒采用Nuss手術(shù)。
[Abstract]:Objective: To summarize the experience of surgical treatment for children with congenital pectus excavatum under the age of 6, and to explore the best surgical treatment plan for children with funnel chest under 6 years old. Materials and methods: thoracic surgery from May 1, 2005 to December 31, 2014 re Affiliated Children's hospital diagnosed as congenital pectus excavatum underwent surgery in 578 cases, 457 cases with complete data, of which 3 years of age underwent modified sternal elevation surgery in 239 cases, 3-6 years old underwent modified sternal elevation surgery patients aged 218,3-6 underwent NUSS surgery in 100 cases, the other collect under the age of 3, the control group were 50 cases, 3-6 years old children with the control group of 50 cases, and retrospective analysis of patient age, clinical manifestation, deformity, deformity type, surgical procedures and postoperative complications and restore the relationship between. Results: under the age of 1.3, a total of 239 people, all for our hospital original modified sternal elevation surgery. The average operation time was 85.47 + 27.15 minutes, the amount of intraoperative bleeding was 2.31 + 3.45ml, of which 31 cases had mild short-term complications, no serious complications, before discharge have been restored to normal, 17 patients had long-term complications after the operation, the satisfaction rate was 97.07%. In the group under 2.3 years old, compared with the normal children's lung function before operation, three cases in TE/TI, V-PF and 25/PF were lower than those in the normal children, and recovered to normal children after operation. The lung function of all F1 groups recovered well. The 3-6 age group the preoperative lung function compared with normal children, postoperative V50 and V25 were lower than the normal children, the modified sternal elevation group, moderate and severe deformity group and pulmonary function recovery were achieved good results, Nuss surgery group severe malformation group after pulmonary function recovery and poor in mild and moderate groups. 3. different deformity children have achieved good results in Nuss surgery and modified sternal elevation surgery, postoperative satisfaction rate reached more than 95%, equivalent to two kinds of surgical effect of mild and moderate deformity in children, severe deformity group with modified sternal elevation surgery is better than Nuss. 4. different deformity children all achieved good results in Nuss surgery and modified sternal elevation, the operation effect of the two groups in symmetric children, some children in non symmetrical, modified sternal elevation surgery is better than Nuss. Conclusion: good results under the age of 1.3 children with pectus excavatum in our hospital for modified sternal elevation to the original, fully restored to normal levels in 2 years following surgery. The pulmonary function after 2.3 years old, the age group of 3-6, there is still a small airway disorder, Nuss surgery group of severe pectus excavatum pulmonary function recovery in mild and moderate group. Pulmonary function in children with modified sternal elevation different deformity recovery showed no significant difference. 3. children with pectus excavatum, mild to moderate group treatment, Nuss group with modified sternal elevation surgery group had no significant difference, severe pectus excavatum, modified sternal elevation surgery treatment group is better than the NUSS group. The 4.3-6 age group in children with pectus excavatum, symmetric pectus excavatum surgery group and Nuss treatment effect of modified sternal elevation surgery group had no significant difference, with asymmetric treatment, modified sternal elevation surgery group is better than that of NUSS type. 5. in summary, through this research, we recommend: A, 3 years old of the following children with pectus excavatum has 2 and above recommended immediate surgery: 1) CT showed that Haller index 3.2 or FI0.3; 2) recurrent upper respiratory tract infection, pneumonia, activity was significantly less than the gestational age, atelectasis, moisture pulmonary function that restrictive ventilation dysfunction; 3) ECG IRBBB, ST-T segment changes, echocardiography revealed heart valve prolapse and other abnormal situations; 4) the degree of deformity and progress of symptoms of children. B, 3-6 years old children were: 1) with severe pectus excavatum, asymmetric pectus excavatum children suggested using modified sternal elevation correction of pectus excavatum; 2) with mild to moderate funnel chest flat chest were treated by Nuss surgery.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R726.5

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