目的总结二次漏斗胸手术经验。 方法回顾性分析我院2009年1月至2015年9月39例二次漏斗胸手术患者的临床资料，男31例、女8例，年龄5～27（13.39±7.61）岁，其中心脏手术后11例、Nuss手术后21例、胸骨翻转术后5例、Ravitch术后2例。单纯凹陷畸形33例，合并前凸畸形6例。Haller指数3.3～6.5（4.53±0.31）。对单纯凹陷畸形采用改良Nuss手术，对合并前凸畸形采用“三明治”手术治疗。 结果本组无死亡病例，多数患者畸形均得到改善，手术时间53～133（79.09±19.13）min，住院时间5～13（7.09±1.90）d。术后并发症包括皮下气肿2例、气胸3例、肺不张1例、胸腔积液1例。随访1～45个月，随访率94.87%。依据漏斗胸术后评价标准进行评价，效果非常满意31例，基本满意7例，不满意1例。 结论采用特殊的手术方法，可以安全完成二次漏斗胸手术。
The autograft and non-autograft cannot meet the needs of clinical vascular surgery. Since there are possibilities of thrombus formation in artificial vascular grafts, the methods for deposing the graft using physical and chemical ways or simply seeding with endothelial cells cannot produce satisfactory grafts for vascular operations until now. In order to increase the anticoagulative capacity of artificial vascular graft, it is rational to use genetic engineering methods modifying the endothelial cells to make it express anticoagulative factors stably. Although seeding artificial graft with the genetically engineered endothelial cells can possibly produce a satisfactory graft for vascular surgery, some problems still need to be solved.
Objective To introduce an integral classification method of thoracic deformity. Methods From March 2015 to March 2017, 869 patients with thoracic deformity were observed. The patients were classified according to the traditional classification method at first, and then were classified according to the integral classification method. According to the standard plane of the normal chest wall, the chest deformities were classified into types Ⅰ and Ⅱ: those below the plane belonged to type Ⅰ, and those above the plane belonged to type Ⅱ. Then two types were divided into subtypes Ⅰ-a, Ⅰ-b, Ⅰ-c, Ⅰ-d, Ⅰ-e, Ⅰ-f, Ⅰ-g and Ⅱ-a, Ⅱ-b, Ⅱ-c, Ⅱ-d according to the specific characteristics of malformation. Results There were 840 patients included in the classification system, accounting for 96.7% of the total patients, and the remaining 29 (3.3%) were complicated malformations, which could not be accurately described by using a single classification type. Compared with the traditional classification methods, patients with pectus excavatum and pectus carinatum were divided into different subtypes. Poland syndrome did not exist any longer, and Dove chest alone became the type Ⅱ-c. Conclusion Integral classification method is a simple and practical classification method. Since the method directly depends on the characteristics of malformation which is related to the operation, it plays a guiding role in the operation. But its superiority needs to be further confirmed.
Objective To introduce a novel classification method for pectus excavatum. Methods A retrospective review of 569 operative patients with pectus excavatum between January 2015 and September 2017 in our hospital was performed. The malformations were described and classified from three dimensions: symmetry (abbreviated as S), depth (abbreviated as D) and position (abbreviated as P). The final integral was calculated according to the deformity index, so that the severity of the deformity could be evaluated. All patients underwent Nuss or modified Nuss surgery. Results All pectus excavatum deformities were classified into 24 types. The most common type was S1D2P1, accounting for 27.2% of the total patients followed by S1D2P2, S1D1P2 and S2D2P2, accounting for 12.0%, 11.6% and 11.4% of all patients respectively. S1D3P3, S1D3P4 and S2D3P3 were not found in our patients. According to the integral, 321 patients were mild, 23 severe, and the rest were moderate. The appearance of all patients improved after the operation. Among them, 405 patients were implanted with a plate, 159 with two plates and 5 with three plates. The length of hospital stay was 5-12 d, with an average of 7.3±1.5 d. Conclusion This classification method is a more comprehensive classification, but its scientific and practical characteristics need to be further confirmed.
ObjectiveTo summarize the experience of surgical treatment of asphyxiating thoracic dysplasia (Jeune syndrome).MethodsA total of 15 patients with asphyxiating thoracic dysplasia from August 2018 to April 2020 in our hospital were retrospectively included. There were 7 males and 8 females, aged 1-25 (8.87±6.71) years. Special steel bars were used to correct the growth direction of the rib and costal cartilage. Meanwhile, the concave and convex deformities of the chest wall on both sides were corrected to increase the chest volume and correct the thoracic deformity.ResultsThe contour appearance of the chest wall of all patients changed after the operation. The shape was close to normal, and the symptoms of hypoxia were improved. The operation time was 147.73±59.78 min, intraoperative bleeding volume was 105.67±91.90 mL, ICU stay time was 14.20±13.54 d and hospital stay time was 26.00±17.87 d. Eleven patients were directly extubated after the operation, 4 patients underwent tracheotomy and received assisted respiration, and the assisted respiration time was 19, 13, 22 and 12 days, respectively. The postoperative chest circumference was significantly increased, and the blood oxygen saturation was significantly improved. There were 5 patients with cardiac insufficiency, and 3 of them were improved by cardiotonic therapy, 2 of them died of heart failure on the 2nd and 31st day after the operation, respectively. Abdominal distention occurred in 10 patients after operation, and 5 of them were obstinate and eliminated by comprehensive treatment. All patients were followed up. The appearance of thorax was improved obviously and there was no sign of compression in lungs. One 13-year-old patient developed respiratory discomfort 3 months after the operation, and the symptoms were relieved after self-administration of oxygen. A 25-year-old patient developed cardiac insufficiency half a month after the discharge, and the symptoms disappeared after cardiotonic treatment. Four patients took out the steel bars in 13, 13, 15 and 17 months after the operation, respectively. The appearance of thorax remained well after the operation. The imaging examination showed that the position of bone structure was normal, the lung field was clear, and there was no sign of chronic inflammation.ConclusionThis technique is a safe and simple operation method. It can not only eliminate the deformity of chest wall, but also increase the volume of chest obviously. However, the long-term effect needs to be further evaluated.