鞍状胸的临床诊断与矫治经验总结

doi:10.3877/cma.j.issn.2095-8773.2024.02.04

中华胸部外科电子杂志 ›› 2024, Vol. 11 ›› Issue (02) : 96 -103. doi: 10.3877/cma.j.issn.2095-8773.2024.02.04

论著

鞍状胸的临床诊断与矫治经验总结

蔡斌¹, 王文林¹^,^†(

), 刘洋¹, 罗娟¹, 郑少毅¹

^1. 510080　广州，广东省第二人民医院胸壁外科

收稿日期:2024-01-09 修回日期:2024-02-28 接受日期:2024-04-16 出版日期:2024-05-28
通信作者: 王文林
基金资助:
广东省第二人民医院院内课题项目(YN2023-002)

Summary of clinical diagnosis and treatment experience of saddle chest

Bin Cai¹, Wenlin Wang¹^,^†(), Yang Liu¹, Juan Luo¹, Shaoyi Zheng¹

^1. Department of Chest Wall Surgery, Guangdong Second Provincial General Hospital, Guangzhou 510080, China

Received:2024-01-09 Revised:2024-02-28 Accepted:2024-04-16 Published:2024-05-28
Corresponding author: Wenlin Wang

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目的

分析鞍状胸的畸形特点、诊断要点、鉴别诊断及手术方式，总结手术治疗经验，为鞍状胸的临床诊治提供参考依据。

方法

回顾分析2022年1月至2023年9月期间在广东省第二人民医院胸壁外科研究院接受手术治疗的鞍状胸病例。收集患者的诊疗信息，包括年龄、性别、临床症状、胸廓畸形特征、影像学检查结果、手术时间、术中出血量、术后住院时间、术后并发症。通过对上述指标进行分析，探讨鞍状胸的畸形特点及手术疗效。

结果

共纳入患者48例，男44例，女4例，年龄5～35（14.0±4.97）岁。其中原发性鞍状胸45例，继发性鞍状胸3例。主诉有不适症状者5例，术前心电图异常者18例。所有患者顺利接受手术治疗，矫治效果满意。其中采用Wenlin+Wung手术术式38例，采用Wenlin+Wang手术术式8例，采用Wung手术术式2例。手术时间20～130（52.50±23.97）min，术中出血1～100（5.0±16.80）mL，术后住院日3～24（6.0±11.90）d。4名患者出现术后切口愈合不良，予清创缝合后治愈。

结论

鞍状胸畸形独特，需要和其他常见的胸廓畸形进行鉴别。手术医生对鞍状胸有充分的认识后，通过采用合适的手术方式，通常能取得满意疗效。

关键词: 胸廓畸形, 鞍状胸, Wenlin手术, Wung手术, Wang手术

Objective

To analyze the characteristics, diagnostic points, differential diagnosis and surgical methods of saddle chest, and summarize the surgical treatment experience, so as to provide reference for the clinical diagnosis and treatment of saddle chest.

Methods

A retrospective analysis was performed on the patients with saddle chest who underwent surgery in the Department of Chest Wall Surgery of Guangdong Second Provincial General Hospital from January 2022 to September 2023. The diagnosis and treatment data of the patients were collected, including age, gender, clinical symptoms, characteristics of thoracic deformity, imaging examination results, operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications. Through the analysis of the above indicators, the deformity characteristics and surgical outcomes of saddle chest were discussed.

Results

A total of 48 patients were enrolled, including 44 males and 4 females, aged from 5–35 (14.0±4.97) years. There were 45 cases and 3 cases of primary saddle chest and secondary saddle chest. Five patients complained of discomfort and 18 patients had abnormal electrocardiogram before the operation. All patients underwent surgical treatment successfully, and the correction effect was satisfactory. Among them, 38 cases were treated with Wenlin + Wung operation, 8 cases with Wenlin + Wang operation, and 2 cases with Wung operation. The operation time was 20–130 (52.50±23.97) min, the intraoperative blood loss was 1–100 (5.0±16.80) mL, and the postoperative hospital stay was 3–24 (6.0±11.90) days. Poor wound healing occurred in 4 patients, who were cured after debridement and suture.

Conclusions

Saddle chest is unique and should be differentiated from other thoracic deformities. After surgeons have a full understanding of saddle chest, through the use of appropriate surgical methods, they usually can achieve satisfactory results.

Key words: Thoracic deformity, Saddle chest, Wenlin procedure, Wung procedure, Wang procedure

图1 鞍状胸外观

图2 鞍状胸患者胸部CT结果。A：上胸平面；B：肋弓根部平面；C：剑突平面；D：肋弓平面

图3 鞍状胸患者手术前后外观对比

图4 鞍状胸大体外观及胸部CT示意图

图5 漏斗胸大体外观及胸部CT示意图

图6 沟状胸大体外观及胸部CT示意图

图7 鸡胸大体外观及胸部CT示意图

图8 正常胸廓及各种胸廓畸形的胸部CT结构模拟示意图。A：正常胸廓；B：鞍状胸；C：漏斗胸；D：沟状胸；E：鸡胸

图9 鞍状胸Wenlin+Wung手术钢板放置结构示意。A，B：蓝圈示两侧下胸壁凹陷部位，鞍状胸两侧肋骨支点处不够高（红线及红圈处）。C，D：先在凹陷部位偏上方胸壁行Wenlin手术。先利用一条钢板将两侧拟放置Wung手术钢板的支点肋骨进行提高固定，为Wung手术的钢板支点创造条件。支点处与第一条钢板两侧固定为一体后，支点应力可分散到第一条钢板上，使支点处不易被Wung手术钢板压塌。E，F：在胸壁凹陷部位行Wung手术，置入蝶形钢板，钢板两侧弧度适当大即可将两侧凹陷的胸壁顶高至黄线处正常高度

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[1]	王文林. 罕见胸廓畸形的手术治疗[J]. 中华胸部外科电子杂志, 2023, 10(02): 70-79.

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