本文選題：漏斗胸 + Nuss術(shù)　； 參考：《華中科技大學(xué)》2013年碩士論文

【摘要】：第一部分不同年齡組漏斗胸Nuss手術(shù)及近期臨床療效的對比研究 目的：回顧性分析不同年齡組漏斗胸Nuss術(shù)圍手術(shù)期情況及臨床療效，探討漏斗胸Nuss術(shù)的適齡年齡。 方法：收集172例漏斗胸患兒行Nuss手術(shù)的臨床資料（所有患兒均為第一次行胸廓矯治術(shù)），分為三個年齡組：A組：3~6歲，包括3歲（n=95），B組：6~12歲，包括6歲、12歲（n=51），C組：12歲以上（n=26）。觀察三組患兒圍手術(shù)期情況，包括手術(shù)時間、術(shù)中出血量、術(shù)后下床時間、術(shù)后住院時間、術(shù)后疼痛程度（采用Wong-baker面部表情量表評分），，統(tǒng)計各組術(shù)后并發(fā)癥，并評定術(shù)后臨床療效（根據(jù)Nuss療效評定標準），進行組間對比分析。 結(jié)果:172例均順利完成手術(shù)。三組患兒中手術(shù)時間，A和B組無統(tǒng)計學(xué)差異(P0.05)，但C組較A、B兩組明顯延長(P0.01)。術(shù)中出血量，A組較B、C兩組明顯減少(P0.01)，B和C組間差異亦有統(tǒng)計學(xué)意義（P0.05）。A、B、C組中年齡越大，術(shù)后下床時間越晚，Wong-baker疼痛程度評分越高，三組間差異均有顯著性統(tǒng)計學(xué)意義(P0.01)。A、B、C三組術(shù)后并發(fā)癥發(fā)生率依次為11.6%、19.6%、30.8%，A和B組及B和C組間無統(tǒng)計學(xué)差異(P0.05)，但A和C組差異有統(tǒng)計學(xué)意義（P0.05）。三組的手術(shù)優(yōu)良度依次為97.9%、96.1%、92.3%，差異無統(tǒng)計學(xué)意義(P0.05)。 結(jié)論：1、不同年齡組漏斗胸Nuss術(shù)后均能獲得較高的手術(shù)優(yōu)良度； 2、年齡越小手術(shù)操作越容易，術(shù)后疼痛越輕、術(shù)后并發(fā)癥越少； 3、漏斗胸Nuss術(shù)的手術(shù)年齡可以提前，并且是安全的。 第二部分不同年齡組漏斗胸Nuss術(shù)術(shù)后生活質(zhì)量及中期療效的觀察 目的：觀察不同年齡組漏斗胸Nuss術(shù)術(shù)后生活質(zhì)量的變化及中期療效。 方法：本研究采用改良M-SSQ版本問卷調(diào)查。由于部分患兒年齡小，不能清楚表達自我感受，首先對大齡組（C組）中的患兒本人和父母進行獨立問卷調(diào)查，并進行相關(guān)度的分析，觀察父母問卷結(jié)果是否可以反映患兒本人手術(shù)前后生活質(zhì)量變化和療效的可行性。然后選取第一部分172例Nuss術(shù)后取出矯形鋼板的85例進行患兒父母的問卷調(diào)查，其中A組45例，B組25例，C組15例，同時對三個組進行Nuss術(shù)后復(fù)發(fā)率的統(tǒng)計。 結(jié)果：C組中患兒本人和父母的問卷結(jié)果一致，具有統(tǒng)計學(xué)意義（Spearman相關(guān)系數(shù)為0.88，P0.05）。A、B、C三個組中對父母的問卷結(jié)果平均總分數(shù)依次為50.93±7.35、49.33±8.62、49.50±5.61，采用Kruskal-Wallis秩和檢驗計算三組間差異無統(tǒng)計學(xué)意義(P0.05)。在胸廓畸形對社會活動存在干擾（問題3）的比例中，A、B、C三個組依次為22.2%、68%、86.7%，A與B、C兩組分別具有顯著性統(tǒng)計學(xué)差異（P0.01）；A、B、C三個組Nuss術(shù)后復(fù)發(fā)率依次為4.4%、4.0%、6.7%，組間差異無統(tǒng)計學(xué)意義(P0.05)。 結(jié)論：1、Nuss術(shù)后父母的問卷結(jié)果可以作為患兒本人的問卷結(jié)果； 2、不同年齡組Nuss術(shù)鋼板取出術(shù)后均可獲得較好的生活質(zhì)量。低年齡組手術(shù)可減少畸形對患兒心理的負面影響，且沒有增加復(fù)發(fā)率； 3、漏斗胸在3-6歲接受Nuss手術(shù)是安全可行的。
[Abstract]:Part one comparative study of Nuss operation and recent clinical efficacy of funnel chest in different age groups
Objective: To retrospectively analyze the perioperative period and clinical efficacy of funnel chest Nuss in different age groups, and to explore the age of Nuss in funnel chest surgery.
Methods: the clinical data of 172 children with funnel chest were collected for Nuss operation (all children were first performed by thoracic orthodontic surgery) and divided into three age groups: group A: 3~6 years old, 3 years old (n=95), B group: 6~12 years old, 12 years (n=51), C group: 12 years old (n=26). The perioperative period of three groups of children, including operation time, intraoperative bleeding, was observed. Volume, postoperative hospital bed time, postoperative hospitalization time, postoperative pain degree (using Wong-baker facial expression scale score), statistical analysis of postoperative complications, and evaluate the postoperative clinical efficacy (according to the evaluation criteria of Nuss effect), the comparative analysis between groups.
Results: the operation time of the 172 cases was successfully completed. There was no significant difference in the operation time between the three groups, A and B group (P0.05), but the group C was significantly longer than A and B two groups (P0.01). The higher the degree score, the difference between the three groups had significant statistical significance (P0.01).A, B, and C three groups were 11.6%, 19.6%, 30.8%, A and B and B and C group had no statistical difference (P0.05), but the A and C group had statistical significance (P0.05). The surgical fineness of the three groups was 97.9%, 96.1%, 92.3%, and the difference was not statistically significant. Meaning (P0.05).
Conclusion: 1. Nuss of funnel chest in different age groups can get a higher degree of operation.
2, the younger the operation, the easier the postoperative pain, the less postoperative complications.
3, the operative age of funnel chest Nuss can be advanced and safe.
The second part is the observation of life quality and mid-term curative effect of funnel chest Nuss after different age groups.
Objective: To observe the quality of life and the medium-term effect of Nuss after pectus excavatum surgery in different age groups.
Methods: a modified M-SSQ version questionnaire was used in this study. Due to the age of some children, they could not express their self feelings clearly. First, we conducted an independent questionnaire survey on the children and their parents in the older group (group C), and analyzed their correlation, and observed whether the results of the parents' questionnaire could reflect the quality of life before and after the operation of the children. The first part of the 172 cases after Nuss removal of orthopedic plate was selected in 85 cases of children's parents, including 45 cases in group A, 25 in group B, 15 in group C, and at the same time, the recurrence rate after Nuss was counted in three groups.
Results: the results of the questionnaire in the C group were consistent with the parents, with statistical significance (Spearman correlation coefficient 0.88, P0.05).A, B, C in the three groups of parents were 50.93 + 7.35,49.33 + 8.62,49.50 + 5.61 respectively, and there was no statistical difference between the three groups using Kruskal-Wallis rank and test (P0.05). In the proportion of social activities (problem 3), the three groups of A, B, and C were 22.2%, 68%, 86.7%, A and B, and C two had significant statistical differences (P0.01); A, B, C three groups were 4.4%, 4%, 6.7%, and there was no significant difference between groups (P0.05).
Conclusion: 1. The parents' questionnaire results after Nuss can be used as the result of the questionnaire.
2, good quality of life can be obtained after removal of Nuss plate in different age groups. Low age group operation can reduce the negative effects of malformation on children's psychology, without increasing the recurrence rate.
3, it is safe and feasible to receive Nuss operation at funnel chest at 3-6 years old.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R655

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本文編號：2064296