台灣漏斗胸(凹胸)病友協會

看到 Jacobs八年前的論文, 當時的手術數量及經驗也不多, 雖說是改良式納氏手術, 可是看來仍與Donald Nuss 的方法原汁原味


Eur J Cardiothorac Surg. 2002 May;21(5):869-73.


Minimally invasive endoscopic repair of pectus excavatum.

漏斗胸的微創內視鏡手術治療


Jacobs JP, Quintessenza JA, Morell VO, Botero LM, van Gelder HM, Tchervenkov CI.


Division of Thoracic and Cardiovascular Surgery, All Children's Hospital/University of South Florida College of Medicine, Cardiac Surgical Associates,
摘要:

Abstract

OBJECTIVE: We report our initial 3 years 4 months' single institution experience in 31 consecutive patients with pectus excavatum treated with minimally invasive endoscopic pectus excavatum repair utilizing a modification of the 'Nuss' technique.

目的:報告三年四個月中單一機構之31例漏斗胸以改良式納氏微創手術經驗.

METHODS: Under general anesthesia, a curved steel bar is individually shaped for each patient to match the ideal chest wall shape and is placed through an endoscopically created retrosternal tunnel between two bilateral midaxillary line 2-cm incisions. The tunnels initially go along the outside of the rib cage, under the pectoral muscles. At the level of the sternum, these tunnels go retrosternal and communicate with each other. The steel bar is passed with the convexity facing posteriorly, within a protective flat silastic drain. Under endoscopic guidance, the curved steel bar is passed through one tunnel, under the sternum, and out the other tunnel. Once positioned, the bar is turned over, thereby correcting the deformity. An epidural catheter provides perioperative pain relief.

方法:在全身麻醉下, 由內視鏡輔助下, 由兩側鎖骨中線間產生胸骨後通道, 並由腋下之2公分刀口, 再置入以個別量製之弧形之金屬矯正板. 置入後, 再翻轉, 而矯正凹陷異常. 手術後以硬膜外止痛.

RESULTS: Minimally invasive endoscopic pectus excavatum repair has been performed on 31 patients (age: range 4.4-31.0 years, median 15.0 years, mean 14.5 years). Median hospital length of stay is 4 days (range 3-10 days, mean 4.6 days). Pneumothorax occurred in five patients requiring tube thoracostomy in three. One patient developed delayed bilateral pleural effusions requiring drainage. Two patients developed evidence of sterile seroma formation at the skin incision several months after minimally invasive repair of pectus excavatum. These seromas resolved with non-interventional conservative medical treatment. No other complications occurred.

結果:31位病人, 年齡由4.4歲至31歲, 平均14.5歲. 平均住院日由3至10天, 平均4.6天. 氣胸發生於5位病人, 其中有三人需置入胸管. 一位病人發生延遲性雙側肋膜積水而需引流, 兩位病人發生切口下積液, 無其他併發症發生.

CONCLUSION: The minimally invasive endoscopic pectus repair is safe and effective and currently our procedure of choice for primary pectus excavatum in all ages. Endoscopic visualization facilitates the safe creation of the retrosternal tunnel. Short-term results have been excellent. Further follow-up will be necessary to determine long-term results.

結論: 微創漏斗胸治療對任何年紀來說均是安全及有效的治療方法. 內視鏡能便利手術的安全進行. 短期看來, 效果良好, 未來需長期追踪其療效.