【摘要】：目的：探討漏斗胸合并先天性心臟病的同期手術(shù)方法及可行性，總結(jié)同期手術(shù)的治療經(jīng)驗(yàn)。 方法：回顧性分析我院胸心外科2003年01月01日至2014年01月01日收治的漏斗胸合并先心病同期手術(shù)的16例患兒，其中男9例，女7例，年齡4月14天~13歲10月（平均年齡3.52±3.30歲），體重5.5~37.0Kg（平均13.22±7.07Kg），其中房間隔缺損11例，室間隔缺損5例，法洛四聯(lián)癥1例；行改良胸骨抬舉術(shù)15例，微創(chuàng)NUSS胸廓矯形術(shù)1例。同時(shí)隨機(jī)選取體重、手術(shù)方式相匹配的16例單純漏斗胸及16例單純先心病患兒作為對照。比較各組的手術(shù)時(shí)間、術(shù)后鎮(zhèn)痛時(shí)間、術(shù)后監(jiān)護(hù)時(shí)間、術(shù)后縱膈引流時(shí)間、引流量、術(shù)后住院時(shí)間、并發(fā)癥及術(shù)后效果。 結(jié)果：本組16例患兒均治愈出院。術(shù)后住院8~18天，平均10.43±2.78天，無1例出現(xiàn)反常呼吸、切口感染等并發(fā)癥。隨訪11月~9年，所有患兒的胸部外觀滿意，其中12例患兒已行鋼板取出，均能維持原有胸廓形態(tài)。復(fù)查彩超心功能正常，無殘余分流等并發(fā)癥。漏斗胸合并先心病患兒與單純先心病的手術(shù)時(shí)間、術(shù)后監(jiān)護(hù)時(shí)間、術(shù)后縱膈引流時(shí)間、引流量及術(shù)后住院時(shí)間比較差異均無統(tǒng)計(jì)學(xué)意義，三組患兒并發(fā)癥比較無明顯差異。 結(jié)論：漏斗胸合并先天性心臟病的同期治療并不增加手術(shù)的風(fēng)險(xiǎn)、并發(fā)癥及術(shù)后恢復(fù)時(shí)間，同期手術(shù)治療安全可行；同期手術(shù)避免了再次手術(shù)的麻醉風(fēng)險(xiǎn)及二次手術(shù)帶來的困難，，節(jié)約醫(yī)療費(fèi)用，減輕了患兒的痛苦；合并先心病的漏斗胸手術(shù)方式首選改良胸骨抬舉術(shù)，尤其是嬰幼兒患者。
[Abstract]:Objective: to explore the method and feasibility of simultaneous operation of funnel chest combined with congenital heart disease and summarize the experience of simultaneous operation. Methods: a retrospective analysis was made on 16 children with funnel chest combined with congenital heart disease, including 9 males and 7 females, who were treated in our hospital from January 01, 2003 to January 01, 2014, in which 9 cases were male and 7 cases were female. The age ranged from 14 days to 13 years old (mean age: 3.52 鹵3.30 years) and weight of 5.5~37.0Kg (mean 13.22 鹵7.07Kg). There were 11 cases of atrial septal defect, 5 cases of ventricular septal defect and 1 case of tetralogy of Fallot. 15 cases underwent modified sternal uplift and 1 case underwent minimally invasive NUSS thoracoplasty. At the same time, 16 cases of simple funnel chest and 16 cases of congenital heart disease were randomly selected as control group. The operation time, postoperative analgesia time, postoperative monitoring time, postoperative mediastinal drainage time, postoperative hospitalization time, postoperative complications and postoperative effect were compared. Results: all 16 cases were cured and discharged. Postoperative hospitalization was 818 days (mean 10.43 鹵2.78 days). No complications such as abnormal respiration and incision infection were found. All the patients were followed up for 11 ~ 9 years. The chest appearance of all the patients was satisfactory, 12 of them had been removed with steel plate, and all of them could maintain the original chest shape. The cardiac function of color Doppler ultrasound was normal and no complications such as residual shunt were found. There was no significant difference in operation time, postoperative monitoring time, postoperative mediastinal drainage time, drainage volume and postoperative hospitalization time between children with congenital heart disease and simple congenital heart disease. There was no significant difference in complications among the three groups. Conclusion: the simultaneous treatment of funnel chest with congenital heart disease does not increase the risk of operation, complications and postoperative recovery time, the simultaneous operation is safe and feasible. At the same time, the operation avoids the anaesthesia risk of reoperation and the difficulty brought by the secondary operation, saves the medical cost and alleviates the pain of the children. The first choice of the funnel chest operation with congenital heart disease is modified sternum lifting, especially the infant patients.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R726.5

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