标题：Wang手术治疗12例漏斗胸患儿的体会

      作者：孙国强，张意平，朱云    孙国强，张意平，朱云郴州市第一人民医院北院(郴州市儿童医院)儿童心胸血管中心，湖南 郴州 423000

      卷次： 2023年34卷22期

      【摘要】 目的 总结采用Wang 手术治疗漏斗胸的体会。方法 回顾性分析2018年10月至2022年2月郴州市儿童医院收治的12例采用Wang手术治疗漏斗胸患儿的临床资料，其中低龄初治11例，NUSS术后复发1例，所有患儿均采用胸骨下段纵行小切口，于胸大肌起始部向肌肉深层游离至胸廓表面，然后再向两侧做胸廓表面的钢板隧道，剪开剑突及部分胸骨，游离胸骨后与膈肌之间的纤维结缔组织。用钢丝于胸骨下段凹陷处及双侧肋弓行贯穿缝合，置入1块预塑形钢板于隧道，调整居中后，提起钢丝将凹陷抬高并固定于钢板中部。结果 所有患儿均以1块矫形板及3根固定钢丝完成Wang手术，手术时间(43±5.7) min，术中出血(7±1.8) mL，住院天数(8±1.4) d。术后患儿恢复良好，无明显其他并发症。术前Haller指数4.49±0.94，术后Haller指数2.57±0.22，差异均有统计学意义(P<0.05)。根据漏斗胸术后评分标准：9分者8例，8分者4例，效果评价均为非常满意。术后随访期间未出现并发症。结论 相对于NUSS手术，Wang手术无论在手术年龄选择、切口、术后恢复及并发症等方面均优势明显，是一种可以考虑的手术方式。
      【关键词】 Wang手术；漏斗胸；小龄儿；微创手术
      【中图分类号】 R726.1 【文献标识码】 A 【文章编号】 1003—6350（2023）22—3305—04

Experience of treating 12 children with pectus excavatum by Wang procedure.
SUN Guo-qiang, ZHANG Yi-ping,ZHU Yun. Children's Thoracic and Cardiovascular Center, Chenzhou First People's Hospital (Chenzhou Children's Hospital),Chenzhou 423000, Hunan, CHINA
【Abstract】 Objective To summarize the application of Wang procedure in the treatment of pectus excavatum.Methods The clinical data of 12 children treated by Wang procedure in Chenzhou Children's Hospital from Oct. 2018to Feb. 2022 were analyzed and summarized, including 11 cases of initial treatment at young age and 1 case with recur-rence after Nuss procedure (one of the procedure for pectus excavatum). Small longitudinal incision of the lower ster-num was used, which started from the initiation of the thoracic muscle to the muscle depth with the way of disassociationtill the thoracic surface. Then the steel plate tunnel was made on the thoracic surface to both sides. The xiphoid and part ofsternum were cut off to free fibre connective tissue between the posterior sternum and the diaphragm. Steel wire was ap-plied through the depression of the lower sternum and the bilateral costal arch, and one pre-formed steel plate was placedin the tunnel. After moderate adjustment, the steal wire was pulled to lift the depression and fix it in the middle of thesteel plate. Results All the patients were operated by Wang procedure with 1 orthopedic plate and 3 fixed steel wires,with operative time of (43±5.7) min, intraoperative bleeding of (7±1.8) mL, and length of hospital stay of (8±1.4) days.The child recovered well after the operation, and no obvious complications were found. Preoperative Haller index was4.49±0.94, and postoperative Haller index was 2.57±0.22, with a statistically significant difference (P<0.05). Based onpostoperative evaluation standard of pectus excavatum, 8 cases scored 9 points and another 4 cases scored 8 points,and the effect evaluation was very satisfactory. No complications occurred during the postoperative follow-up period.Conclusion Compared with the classic Nuss procedure, Wang procedure has obvious advantages in terms of operationage selection, incision, postoperative recovery, and complications. In conclusion, Wang procedure is a surgical optionthat can be considered.
      【Key words】 Wang procedure; Pectus excavatum; Young children; Minimally invasive surgery