本文選題：Nuss手術(shù) + 漏斗胸　； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景:漏斗胸是一種常見的先天性胸廓畸形,發(fā)病率為0.1%～0.3%,其主要特點(diǎn)是以劍突為中心的胸骨下段及相應(yīng)的肋軟骨向后凹陷。嚴(yán)重情況下凹陷的胸骨會(huì)壓迫心臟和肺組織,降低肺活量,影響患者的心肺功能。同時(shí)胸壁畸形的外觀,會(huì)造成患者自卑感,心理損害。矯治漏斗胸的手術(shù)方式有多種,包括胸骨抬舉術(shù)(Ravitch術(shù))、胸骨翻轉(zhuǎn)手術(shù)和微創(chuàng)Nuss手術(shù)。幾種手術(shù)方式都有各自的特點(diǎn)。Nuss手術(shù)以其微創(chuàng)、便捷等優(yōu)勢,成為時(shí)下外科醫(yī)生最為推崇的漏斗胸矯治手術(shù)方式。在Nuss手術(shù)中,通過在患者胸骨后置入矯形鋼板,強(qiáng)制性抬高凹陷的胸骨,達(dá)到矯正漏斗胸的目的。但近年來Nuss手術(shù)并發(fā)癥發(fā)生率并未明顯下降,主要并發(fā)癥包括術(shù)后疼痛、傷口感染及氣胸等一般并發(fā)癥和心臟損傷、肺損傷、膈肌損傷及矯形鋼板移位等嚴(yán)重并發(fā)癥。國內(nèi)外學(xué)者為了避免這些并發(fā)癥的發(fā)生,對(duì)手術(shù)進(jìn)行了諸多改良和創(chuàng)新,但術(shù)中心、肺損傷等災(zāi)難性并發(fā)癥仍有報(bào)道。因此,改進(jìn)Nuss手術(shù)使其更為微創(chuàng)、便捷,同時(shí)減少嚴(yán)重并發(fā)癥的發(fā)生率,具有重要的臨床應(yīng)用意義。研究目的:本研究旨在探討新設(shè)計(jì)的指觸引導(dǎo)技術(shù)在Nuss手術(shù)中的應(yīng)用,以避免嚴(yán)重并發(fā)癥的發(fā)生,并分析該技術(shù)的可行性、便捷性及安全性。方法:回顧性分析2012年1月至2015年12月期間收治的76名漏斗胸患者,男63例,女13例,年齡范圍6-29歲,平均13.3歲,將其分為指觸組(34例)和對(duì)照組(42例)。指觸組是在Nuss手術(shù)中做雙側(cè)腋前線20mm長切口,并建立肌下隧道進(jìn)胸。手指探查胸腔并在胸骨后與對(duì)側(cè)胸腔的引導(dǎo)器尖端接觸,在確認(rèn)其間無心、肺、膈肌等重要組織后,引導(dǎo)器在手指引導(dǎo)下穿過胸骨后組織到相應(yīng)位置,從而避免心、肺等組織損傷。術(shù)中不使用胸腔鏡、引流管及鋼板固定器。對(duì)照組采用經(jīng)典的Nuss術(shù)式。將兩組患者的圍手術(shù)期情況,術(shù)中情況,主要并發(fā)癥的發(fā)生率,住院費(fèi)用和術(shù)后滿意度進(jìn)行對(duì)比分析。研究結(jié)果:(1)76例患者均順利完成手術(shù),指觸組的平均手術(shù)時(shí)間明顯少于對(duì)照組(39.10±10.01vs70.15±12.87min,P=0.0280.05)。(2)指觸組的術(shù)后平均住院天數(shù)少于對(duì)照組(2.81±0.71vs 4.01±0.81d,P=0.0480.05)。(3)指觸組主要并發(fā)癥發(fā)生率明顯少于對(duì)照組(8.82%vs 26.19%,P=0.0410.05)。(4)兩組患者的術(shù)后滿意度無顯著性差異(P=0.7540.05)。(5)指觸組平均住院費(fèi)用少于對(duì)照組(34519±2124.12 vs 42240±1520.24,P=0.0430.05)。結(jié)論:新設(shè)計(jì)的指觸引導(dǎo)技術(shù)通過手指的保護(hù)和引導(dǎo)使漏斗胸的Nuss手術(shù)中引導(dǎo)器通過胸骨后盲區(qū)的過程更為安全,可最大限度地避免術(shù)中心、肺及大血管等重要臟器的損傷。手術(shù)過程中不需使用胸腔鏡、鋼板固定片及胸腔引流管。應(yīng)用該技術(shù)使手術(shù)的住院費(fèi)用明顯降低,并且更為安全、微創(chuàng)、便捷,值得進(jìn)一步推廣應(yīng)用。
[Abstract]:Background: funnel chest is a common congenital thoracic malformation with incidence of 0.1% 0.3%. Its main feature is the inferior sternum and the corresponding depressions of costal cartilage centered on the process of the sword. In severe cases, the depressed sternum compresses the heart and lung tissue, reduces vital capacity, and affects the patient's cardiopulmonary function. At the same time, the appearance of the deformity of the chest wall will cause inferiority complex and psychological damage. There are a variety of surgical methods for the correction of funnel chest, including sternum uplift (Ravitch), sternum turnover and minimally invasive Nuss operation. Several surgical methods have their own characteristics. Nuss surgery with its advantages of minimally invasive convenient and so on has become the most respected surgery method of funnel chest surgery. In the Nuss procedure, orthopedic plate was placed behind the sternum of the patient, and the depressed sternum was forced to be raised to correct the funnel chest. However, the incidence of complications in Nuss surgery has not decreased significantly in recent years. The main complications include postoperative pain, wound infection, pneumothorax, heart injury, lung injury, diaphragm injury and orthopedic plate displacement. In order to avoid these complications, scholars at home and abroad have made many improvements and innovations in the operation, but the surgical center, lung injury and other catastrophic complications are still reported. Therefore, improving Nuss operation to make it more minimally invasive and convenient, while reducing the incidence of serious complications, has important clinical significance. Objective: the purpose of this study was to explore the application of the newly designed touch guide technique in Nuss operation in order to avoid serious complications and to analyze the feasibility, convenience and safety of the technique. Methods: from January 2012 to December 2015, 76 patients with funnel chest were retrospectively analyzed, including 63 males and 13 females, aged 6-29 years (mean 13.3 years). The patients were divided into finger touch group (34 cases) and control group (42 cases). The finger contact group underwent bilateral axillary front 20mm long incision and established a submuscular tunnel into the chest. The finger explores the chest and contacts the tip of the contralateral chest with the guide behind the sternum. After confirming that there is no heart, lung, diaphragm, and other important tissues, the guide passes through the sternum to the appropriate position under the guidance of the finger, thus avoiding the heart. Lung and other tissue damage. Thoracoscope, drainage tube and plate fixator were not used during the operation. The control group was treated with classical Nuss procedure. The perioperative period, intraoperative conditions, incidence of major complications, hospitalization costs and postoperative satisfaction were compared between the two groups. The results were as follows: (1) 76 patients completed the operation successfully. The average operation time in the finger touch group was significantly less than that in the control group (39.10 鹵12.87min 鹵12.87min, P < 0.0280.05). (2). The average postoperative hospitalization days in the finger touch group was significantly less than that in the control group (2.81 鹵0.71vs 4.01 鹵0.81dP 0.0480.05). (3). The incidence of major complications in the finger touch group was significantly lower than that in the control group (8.82%vs 26.19g P0.0410.05). (4). There was no significant difference in postoperative satisfaction between the two groups. The average hospitalization cost in the touch group was lower than that in the control group (34519 鹵2124.12 vs 42240 鹵1520.24). (5). Conclusion: the newly designed finger touch guidance technique can make the process of the guide through the posterior blind area of sternum in the Nuss operation of funnel chest more safe through the protection and guidance of the fingers, and can avoid the injury of important organs such as the center of operation, lung and large blood vessels to the maximum extent. There is no need for thoracoscopy, plate fixation and thoracic drainage during surgery. The application of this technique can significantly reduce the hospitalization cost of the operation, and be more safe, minimally invasive, convenient and worthy of further popularization and application.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R655

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本文編號(hào)：2100020