• 北京軍區(qū)總醫(yī)院（北京，100700）1胸外科，2放射診斷科;

目的通過比較手術(shù)前后漏斗胸患者心功能和心臟形態(tài)，探討前胸壁凹陷畸形對(duì)心臟影響及微創(chuàng)外科治療療效。 方法2009年8月－2010年12月，采用微創(chuàng)外科矯治102例成人漏斗胸患者。男84例，女18例；年齡18～57歲，平均 23.4歲。初次手術(shù)95例，二次手術(shù)7例。漏斗胸分型：Ⅰ型59例，Ⅱ型43例。漏斗胸指數(shù)（haller index，HI）為4.59 ± 1.51。42例出現(xiàn)臨床癥狀，19例出現(xiàn)心臟體征。術(shù)前胸部CT檢查示，患者心臟均受壓，心臟移位74例。超聲心動(dòng)圖檢查左室射血分?jǐn)?shù)（left ventricular ejection fraction，LVEF）為68.9% ± 6.2%。 結(jié)果患者矯治手術(shù)均順利完成，無死亡及嚴(yán)重并發(fā)癥發(fā)生。102例均獲隨訪，隨訪時(shí)間12～28個(gè)月，平均21個(gè)月。術(shù)后患者臨床癥狀及心臟體征均消失。術(shù)后12個(gè)月HI 為2.70 ± 0.33，與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義（t=5.83，P=0.00）。參照Nuss等的方法評(píng)定胸廓形狀，獲優(yōu)99例，良3例。術(shù)后12個(gè)月胸部CT檢查示101例完全解除心臟壓迫，1例心臟仍輕度受壓；心臟位置恢復(fù)正常。心電圖檢查示4例術(shù)前異?；颊呋謴?fù)正常。超聲心動(dòng)圖檢查示LVEF為70.5% ± 4.8%，與術(shù)前比較差異無統(tǒng)計(jì)學(xué)意義（t=1.08，P=0.30）。 結(jié)論成人漏斗胸前胸壁凹陷畸形對(duì)心臟的影響主要是壓迫和推移，微創(chuàng)外科治療可有效解除心臟壓迫，消除臨床癥狀。

引用本文： 劉吉福,劉濤,徐波,裴迎新. 微創(chuàng)外科治療成人漏斗胸療效觀察. 中國(guó)修復(fù)重建外科雜志, 2012, 26(9): 1084-1087. doi: 復(fù)制

1. Kragten HA, Siebenga J, Höppener PF, et al. Symptomatic pectus excavatum in seniors (SPES): a cardiovascular problem? : A prospective cardiological study of 42 senior patients with a symptomatic pectus excavatum. Neth Heart J, 2011, 19(2): 73-78.
2. Jacobsen EB, Thastum M, Jeppesen JH, et al. Health-related quality of life in children and adolescents undergoing surgery for pectus excavatum. Eur J Pediatr Surg, 2010, 20(2): 85-91.
3. Jaroszewski DE, Fonkalsrud EW. Repair of pectus chest deformities in 320 adult patients: 21 year experience. Ann Thorac Surg, 2007, 84(2): 429-433.
4. Kim M, Lee KY, Park HJ, et al. Development of new cardiac deformity indexes for pectus excavatum on computed tomography: feasibility for pre- and post-operative evaluation. Yonsei Med J, 2009, 50(3): 385-390.
5. 劉吉福, 徐波, 武珊珊. 微創(chuàng)手術(shù)矯治兒童漏斗胸后胸廓骨重塑與臨床療效. 中國(guó)胸心血管外科臨床雜志, 2012, 19(1): 39-42.
6. Nuss D, Kelly RE Jr. Indications and technique of Nuss procedure for pectus excavatum. Thorac Surg Clin, 2010, 20(4): 583-597.
7. Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
8. Malek MH, Coburn JW. Strategies for cardiopulmonary exercise testing of pectus excavatum patients. Clinics (Sao Paulo), 2008, 63(2): 245-254.
9. Saleh RS, Finn JP, Fenchel M, et al. Cardiovascular magnetic resonance in patients with pectus excavatum compared with normal controls. J Cardiovasc Magn Reson, 2010, 12: 73.
10. Tang M, Nielsen HH, Lesbo M, et al. Improved cardiopulmonary exercise function after modified Nuss operation for pectus excavatum. Eur J Cardiothorac Surg, 2012, 41(5): 1063-1067.
11. Croitoru DP, Kelly RE Jr, Goretsky MJ, et al. The minimally invasive Nuss technique for recurrent or failed pectus excavatum repair in 50 patients. J Pediatr. Surg, 2005, 40(1): 181-186.
12. Guldemond FI, Höppener PF, Kraqten JA, et al. Cardiac symptoms due to pectus excavatum in a man over the age of 55. Ned Tijdschr Geneeskd, 2008, 152(6): 337-341.
13. Kelly RE, Goretsky MJ, Obermeyer R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg, 2010, 252(6): 1072-1081.
14. Swanson JW, Avansino JR, Phillips GS, et al. Correlating Haller Index and cardiopulmonary disease in pectus excavatum. Am J Surg, 2012, 203(5): 660-664.
  1. 1. Kragten HA, Siebenga J, Höppener PF, et al. Symptomatic pectus excavatum in seniors (SPES): a cardiovascular problem? : A prospective cardiological study of 42 senior patients with a symptomatic pectus excavatum. Neth Heart J, 2011, 19(2): 73-78.
  2. 2. Jacobsen EB, Thastum M, Jeppesen JH, et al. Health-related quality of life in children and adolescents undergoing surgery for pectus excavatum. Eur J Pediatr Surg, 2010, 20(2): 85-91.
  3. 3. Jaroszewski DE, Fonkalsrud EW. Repair of pectus chest deformities in 320 adult patients: 21 year experience. Ann Thorac Surg, 2007, 84(2): 429-433.
  4. 4. Kim M, Lee KY, Park HJ, et al. Development of new cardiac deformity indexes for pectus excavatum on computed tomography: feasibility for pre- and post-operative evaluation. Yonsei Med J, 2009, 50(3): 385-390.
  5. 5. 劉吉福, 徐波, 武珊珊. 微創(chuàng)手術(shù)矯治兒童漏斗胸后胸廓骨重塑與臨床療效. 中國(guó)胸心血管外科臨床雜志, 2012, 19(1): 39-42.
  6. 6. Nuss D, Kelly RE Jr. Indications and technique of Nuss procedure for pectus excavatum. Thorac Surg Clin, 2010, 20(4): 583-597.
  7. 7. Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
  8. 8. Malek MH, Coburn JW. Strategies for cardiopulmonary exercise testing of pectus excavatum patients. Clinics (Sao Paulo), 2008, 63(2): 245-254.
  9. 9. Saleh RS, Finn JP, Fenchel M, et al. Cardiovascular magnetic resonance in patients with pectus excavatum compared with normal controls. J Cardiovasc Magn Reson, 2010, 12: 73.
  10. 10. Tang M, Nielsen HH, Lesbo M, et al. Improved cardiopulmonary exercise function after modified Nuss operation for pectus excavatum. Eur J Cardiothorac Surg, 2012, 41(5): 1063-1067.
  11. 11. Croitoru DP, Kelly RE Jr, Goretsky MJ, et al. The minimally invasive Nuss technique for recurrent or failed pectus excavatum repair in 50 patients. J Pediatr. Surg, 2005, 40(1): 181-186.
  12. 12. Guldemond FI, Höppener PF, Kraqten JA, et al. Cardiac symptoms due to pectus excavatum in a man over the age of 55. Ned Tijdschr Geneeskd, 2008, 152(6): 337-341.
  13. 13. Kelly RE, Goretsky MJ, Obermeyer R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg, 2010, 252(6): 1072-1081.
  14. 14. Swanson JW, Avansino JR, Phillips GS, et al. Correlating Haller Index and cardiopulmonary disease in pectus excavatum. Am J Surg, 2012, 203(5): 660-664.