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目的介绍微创NUSS改良术治疗小儿特殊类型漏斗胸的手术方法、并发症和临床初步经验。方法NUSS改良术治疗小儿特殊类型漏斗胸17例,扁平胸型漏斗胸11例,不对称型漏斗胸6例。胸腔镜辅助下行微创手术16例,合并肺囊肿同时开胸行右肺下叶尖段切除术1例。结果 16例手术均顺利完成,术中无并发症。16例在胸腔镜辅助下行微创手术时间30 min,1例先用胸腔镜观察肺部病变同术前CT,开胸行肺切除后同时放支撑架矫形,时间60 min。早期无并发症。术后3个月时一侧伤口出现缝线反应1例,于术后4个月提前取出支撑架,复发。结论微创NUSS改良术治疗小儿特殊类型漏斗胸的手术方法安全可行,尤其对扁平胸型漏斗胸、不对称型漏斗胸创伤小、手术时间短、矫形满意,大龄儿童不受年龄限制。
Objective To introduce the minimally invasive NUSS modified surgery in children with special type of funnel chest surgery, complications and clinical preliminary experience. Methods NUSS modified surgery in children with special type of funnel chest in 17 cases, flat chest funnel chest in 11 cases, 6 cases of asymmetric funnel chest. Sixteen patients underwent minimally invasive thoracoscopic surgery assisted with minimally invasive surgery, and one patient underwent simultaneous lobectomy of right lower lobe with thoracotomy. Results 16 cases were successfully completed, no complications during operation. Sixteen patients underwent thoracoscopic assisted mini-invasive surgery for 30 min. One patient underwent thoracoscope to observe the pulmonary lesion with preoperative CT. Thoracotomy and pneumoectomy were performed at the same time. The time was 60 min. No complications early. At 3 months after operation, one side of the wound appeared suture reaction, and 4 months after the operation, the stent was removed early and recurred. Conclusion Minimally invasive NUSS modified surgical treatment of children with special type of funnel chest surgery is safe and feasible, especially for flat chest funnel chest, asymmetric funnel chest trauma, short operative time, orthopedic satisfaction, older children without age restriction.