本文選題：漏斗胸 + 新型��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景漏斗胸是最常見的胸廓畸形,發(fā)病率約為0.1-0.3%。目前,手術(shù)治療是最為有效的治療方式。1998年Nuss[1]提出微創(chuàng)治療漏斗胸的概念,此后微創(chuàng)手術(shù)逐漸取代了傳統(tǒng)開胸手術(shù)。近年來漏斗胸手術(shù)不斷得到改良,不斷向著更加美觀,更加微創(chuàng)的方向發(fā)展。在大量Nuss手術(shù)的基礎(chǔ)上,我們對手術(shù)器械及手術(shù)方式進(jìn)行改進(jìn)并取得專利,于2010年11月開展首例新型微創(chuàng)術(shù)式治療漏斗胸,目前尚未發(fā)現(xiàn)此種新型術(shù)式與Nuss手術(shù)的對比性研究的相關(guān)報道。目的探討新型微創(chuàng)漏斗胸矯形術(shù)對于不同年齡組漏斗胸患者治療的影響,探討這種新型微創(chuàng)手術(shù)的安全性及有效性。通過對比分析新型微創(chuàng)手術(shù)與Nuss手術(shù)兩種不同手術(shù)方法的臨床資料,研究兩種手術(shù)方式治療下,不同年齡組患者漏斗胸指數(shù)(Haller指數(shù))的變化、圍手術(shù)期情況、術(shù)后并發(fā)癥及兩種手術(shù)方式的手術(shù)器械、手術(shù)操作的異同,為臨床上漏斗胸的手術(shù)治療提供相關(guān)參考方案。方法收集我院2010年11月—2016年11月接受新型微創(chuàng)漏斗胸矯形術(shù)并已取出矯形板的的患者219例作為實(shí)驗(yàn)組,按照年齡將其分為2組:A組為12歲及以下組147例,采用單切口單根矯形板的手術(shù)方案(即漏斗胸單孔矯形術(shù));B組為12歲以上組72例。采用置入單根或兩根矯形板的手術(shù)方案。選取2008年2月—2012年6月接受Nuss手術(shù)并已取出矯形板的患兒235例,按照同樣的方法分組后設(shè)為對照組,通過回顧性對比實(shí)驗(yàn)研究,對比分析兩種手術(shù)方式下不同年齡組患者Haller指數(shù)的變化,圍手術(shù)期情況(包括手術(shù)時間、術(shù)中出血量、術(shù)后住院時間)、術(shù)后并發(fā)癥的發(fā)生率及手術(shù)效果進(jìn)行組間對比分析,評定術(shù)后的臨床療效。結(jié)果實(shí)驗(yàn)組和對照組病例全部順利完成手術(shù)。12歲以下年齡組:實(shí)驗(yàn)組和對照組術(shù)后Haller指數(shù)較術(shù)前改善明顯,差異有統(tǒng)計學(xué)意義;矯形板置入后與矯形板取出后Haller指數(shù)未出現(xiàn)明顯改變,差異無統(tǒng)計學(xué)意義;實(shí)驗(yàn)組手術(shù)時間明顯少于對照組,差異有統(tǒng)計學(xué)意義;實(shí)驗(yàn)組與對照組出血量,術(shù)后住院天數(shù)、術(shù)后并發(fā)癥發(fā)生率、療效評價差異無統(tǒng)計學(xué)意義。12歲以上年齡組:實(shí)驗(yàn)組和對照組術(shù)后Haller指數(shù)較術(shù)前改善明顯,差異有統(tǒng)計學(xué)意義;矯形板置入后與矯形板取出后Haller指數(shù)未出現(xiàn)明顯改變,差異無統(tǒng)計學(xué)意義;實(shí)驗(yàn)組手術(shù)時間明顯少于對照組,差異有統(tǒng)計學(xué)意義;實(shí)驗(yàn)組與對照組出血量,術(shù)后住院天數(shù)、術(shù)后并發(fā)癥發(fā)生率、療效評價差異無統(tǒng)計學(xué)意義。結(jié)論新型微創(chuàng)漏斗胸矯形術(shù)與Nuss手術(shù),術(shù)后患者的Haller指數(shù)較術(shù)前均明顯得到改善,兩種手術(shù)方式均可有效治療不同年齡段的漏斗胸患者。新型微創(chuàng)漏斗胸矯形術(shù)與其相比,安全性及有效性無顯著性差異,且手術(shù)時間明顯縮短,操作更加簡便,更加微創(chuàng),是一種安全有效的微創(chuàng)手術(shù)方式。
[Abstract]:Background the funnel chest is the most common thoracic malformation with an incidence of 0.1-0.3. At present, surgical treatment is the most effective treatment. In 1998, Nuss [1] put forward the concept of minimally invasive treatment of funnel chest. Since then, minimally invasive surgery has gradually replaced the traditional thoracotomy. In recent years, funnel chest surgery has been continuously improved to a more beautiful, more minimally invasive direction. On the basis of a large number of Nuss operations, we have improved and patented the surgical instruments and methods. In November 2010, we carried out the first new minimally invasive operation to treat funnel chest. At present, there is no report on the comparative study of this new type of operation and Nuss operation. Objective to investigate the effect of new minimally invasive funnel chest orthopedics on patients with funnel chest in different age groups, and to explore the safety and effectiveness of the new minimally invasive surgery. By comparing and analyzing the clinical data of new minimally invasive surgery and Nuss operation, the changes of pectus funnel index (Haller index) and perioperative period of patients with different age groups were studied. The postoperative complications and two kinds of surgical instruments, the similarities and differences of the operation procedures, provide the relevant reference scheme for the clinical operation of funnel chest. Methods from November 2010 to November 2016, 219 patients with new minimally invasive funnel chest orthopedic surgery were selected as experimental group. According to their age, they were divided into two groups: group A, group 12, and group A, with 147 cases under 12 years of age. A single incision and single orthopedic plate was used. 72 cases of group B were over 12 years old. A single orthopedic plate or two orthopedic plates were implanted. From February 2008 to June 2012, 235 children undergoing Nuss operation and having removed the orthopedic plate were divided into two groups as control group according to the same method. The changes of Haller index in different age groups, perioperative period (including operation time, intraoperative bleeding, postoperative hospitalization time, incidence of postoperative complications and operative effect) were compared and analyzed. To evaluate the clinical effect after operation. Results all the patients in the experimental group and the control group had successfully completed the operation. The Haller index in the experimental group and the control group was significantly improved after operation compared with that before operation, and the difference was statistically significant. There was no significant change in Haller index after orthopedic plate placement and orthopedic plate removal, the difference was not statistically significant; the operative time in the experimental group was significantly shorter than that in the control group, and the difference was statistically significant. There was no significant difference in the incidence of postoperative complications and the evaluation of curative effect. The Haller index in the experimental group and the control group was significantly improved compared with that in the pre-operation group, and the difference was statistically significant. There was no significant change in Haller index after orthopedic plate placement and orthopedic plate removal, the difference was not statistically significant; the operative time in the experimental group was significantly shorter than that in the control group, and the difference was statistically significant. There was no significant difference in the incidence of postoperative complications and the evaluation of curative effect. Conclusion the Haller index of patients with new minimally invasive orthopedic funnel chest surgery and Nuss operation were improved significantly compared with those before operation. The two surgical methods can effectively treat patients with funnel chest in different ages. Compared with the new minimally invasive orthopedic operation of funnel chest, there is no significant difference in safety and effectiveness, and the operation time is obviously shortened, the operation is more simple and minimally invasive, and it is a safe and effective minimally invasive operation method.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R655

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