胸廓畸形手术失败后再次手术的单中心回顾性分析

doi:10.3877/cma.j.issn.2095-8773.2026.01.03

中华胸部外科电子杂志 ›› 2026, Vol. 13 ›› Issue (01) : 28 -35. doi: 10.3877/cma.j.issn.2095-8773.2026.01.03

论著

胸廓畸形手术失败后再次手术的单中心回顾性分析

蔡斌, 王文林^†(

), 龙伟光, 刘洋, 罗娟, 郑少毅, 曾子安, 李娜, 龚雯

510080　广州，暨南大学附属广东省第二人民医院胸壁外科研究院

收稿日期:2025-12-24 修回日期:2026-01-23 接受日期:2026-02-06 出版日期:2026-02-28
通信作者: 王文林
基金资助:
广东省第二人民医院三家四青科研基金项目(2024B001)

A single-center retrospective analysis of reoperation after failed thoracic deformity surgery

Bin Cai, Wenlin Wang^†(), Weiguang Long, Yang Liu, Juan Luo, Shaoyi Zheng, Zian Zeng, Na Li, Wen Gong

Institute of the Chest Wall Surgery, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou 510080, China

Received:2025-12-24 Revised:2026-01-23 Accepted:2026-02-06 Published:2026-02-28
Corresponding author: Wenlin Wang

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引用本文：

蔡斌, 王文林, 龙伟光, 刘洋, 罗娟, 郑少毅, 曾子安, 李娜, 龚雯. 胸廓畸形手术失败后再次手术的单中心回顾性分析[J/OL]. 中华胸部外科电子杂志, 2026, 13(01): 28-35.

Bin Cai, Wenlin Wang, Weiguang Long, Yang Liu, Juan Luo, Shaoyi Zheng, Zian Zeng, Na Li, Wen Gong. A single-center retrospective analysis of reoperation after failed thoracic deformity surgery[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2026, 13(01): 28-35.

目的

总结分析胸廓畸形手术失败病例的病因、临床特点以及再次手术的方法与技术要点。

方法

回顾性分析2018年1月至2025年12月广东省第二人民医院胸壁外科收治的因院外胸廓畸形手术失败后而前来接受再次手术的病例资料，包括患者一般信息、畸形特征、影像学结果、手术时间、术中出血量、术后住院时间、术后并发症等。对上述结果进行统计分析。

结果

纳入患者312例，男258例，女54例，年龄3~49（19.98±9.83）岁。原发病为漏斗胸270例，鸡胸18例，复合畸形9例，类型不详15例。分别以Wang手术、Wung手术、Wenlin手术、Wang+Wung手术、Wang+Wenlin手术、Wung+Wenlin手术以及综合手术对患者实施再次手术。总手术时间55~285（134.21±52.04）min，术中出血量2~500（74.63±114.48）mL，术后住院时间4~60（10.54±6.78）天。随访时间最长93个月，其中126例已拆除钢板，拆除钢板后的患者随访暂未见明显畸形复发。

结论

胸廓畸形手术一旦失败，再次手术风险高，难度大，需要采用特殊方法才能实施再次手术矫正。

关键词: 胸廓畸形, 漏斗胸, 鸡胸, 矫形手术, 二次手术

Objective

To analyze the causes, clinical characteristics and key points of reoperation for thoracic deformity.

Methods

From January 2018 to December 2025 in The Affiliated Guangdong Second Provincial General Hospital of Jinan University, the clinical data of patients with thoracic deformity who underwent reoperation after failed surgery outside the hospital were retrospectively analyzed, including general information of patients, deformity characteristics, imaging results, operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications. The above results were statistically analyzed.

Results

A total of 312 patients were enrolled, including 258 males and 54 females, aged from 3 to 49 (19.98±9.83) years old. There were 270 cases of pectus excavatum, 18 cases of pectus carinatum, 9 cases of compound deformity, and 15 cases of unknown type. The patients were treated with Wang procedure, Wung procedure, Wenlin procedure, Wang + Wung procedure, Wang + Wenlin procedure, Wung + Wenlin procedure and comprehensive procedure, respectively. The total operation time was 55–285 (134.21±52.04) min, the intraoperative blood loss was 2–500 (74.63±114.48) mL, and the postoperative hospital stay was 4–60 (10.54±6.78) days. The longest follow-up time was 93 months, in which the steel plate had been removed in 126 cases, and there was no obvious recurrence of deformity during the follow-up after removal of the steel bars.

Conclusions

Once the thoracic deformity surgery fails, the risk of reoperation is high, and the procedure is technically difficult. Special methods are required for reoperation.

Key words: Thoracic deformity, Pectus excavatum, Pectus carinatum, Orthopedic surgery, Reoperation

表1 患者详细既往病史、手术史及一般资料

参数	数量
性别
男	258
女	54
年龄（岁）	3~49（19.98±9.83）
原发胸廓畸形类型
漏斗胸	270
鸡胸	18
复合畸形	9
类型不详	15
既往接受手术次数
1次	270
2次	24
3次	9
4次	3
5次	3
次数不详	3
既往接受手术术式
胸骨翻转术	7
剑突切除术	2
Ravitch手术	21
Nuss手术	159
Abramson手术	12
Sandwich手术	3
术式不详	108
既往使用钢板条数
1条	141
2条	30
3条	6
数量不详	135

表1 患者详细既往病史、手术史及一般资料

参数	数量
性别
男	258
女	54
年龄（岁）	3~49（19.98±9.83）
原发胸廓畸形类型
漏斗胸	270
鸡胸	18
复合畸形	9
类型不详	15
既往接受手术次数
1次	270
2次	24
3次	9
4次	3
5次	3
次数不详	3
既往接受手术术式
胸骨翻转术	7
剑突切除术	2
Ravitch手术	21
Nuss手术	159
Abramson手术	12
Sandwich手术	3
术式不详	108
既往使用钢板条数
1条	141
2条	30
3条	6
数量不详	135

表2 再次手术术式与钢板使用情况及围手术期指标

再次手术术式	使用钢板数（条）	例数	手术时间（min）	术中出血量（mL）
Wang手术	1	15	88~160	2~15
	2	21	95~281	5~200
	3	6	191~209	50~100
Wung手术	1	6	83~114	10~20
	2	75	69~186	2~50
	3	3	97~145	50~160
Wenlin手术	1	6	81~123	20~100
	2	18	73~153	5~20
Wang+Wung手术	2	24	64~233	17.5±170
	3	21	94~275	100±180
Wang+Wenlin手术	2	15	125~254	5~300
	3	9	144~215	200~300
Wung+Wenlin手术	2	45	55~150	2~200
	3	36	71~273	50±185
综合术式	4	12	155~285	100~500

表2 再次手术术式与钢板使用情况及围手术期指标

再次手术术式	使用钢板数（条）	例数	手术时间（min）	术中出血量（mL）
Wang手术	1	15	88~160	2~15
	2	21	95~281	5~200
	3	6	191~209	50~100
Wung手术	1	6	83~114	10~20
	2	75	69~186	2~50
	3	3	97~145	50~160
Wenlin手术	1	6	81~123	20~100
	2	18	73~153	5~20
Wang+Wung手术	2	24	64~233	17.5±170
	3	21	94~275	100±180
Wang+Wenlin手术	2	15	125~254	5~300
	3	9	144~215	200~300
Wung+Wenlin手术	2	45	55~150	2~200
	3	36	71~273	50±185
综合术式	4	12	155~285	100~500

图1 17岁男性，首次手术失败，二次漏斗胸。A：术前胸廓大体外观；B，C：CT影像；D：广东省第二人民医院胸壁外科再次行Wang+Wung手术矫治后大体外观。CT：计算机断层扫描

图2 17岁男性，首次手术失败继发复合畸形。A：术前胸廓大体外观；B，C：三维重建；D：CT影像；E：广东省第二人民医院胸壁外科再次行Wang+Wenlin手术矫治后大体外观。CT：计算机断层扫描

图3 14岁男性，Nuss手术失败继发前凸畸形。A：术前胸廓大体外观；B：三维重建；C：广东省第二人民医院胸壁外科再次行Wung+Wenlin手术矫治后大体外观

图4 14岁女性，Nuss手术失败，二次漏斗胸。A：术前胸廓大体外观；B，C：三维重建；D：CT影像；E：广东省第二人民医院胸壁外科再次行Wung+Wenlin手术矫治后大体外观。CT：计算机断层扫描

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A single-center retrospective analysis of reoperation after failed thoracic deformity surgery

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A single-center retrospective analysis of reoperation after failed thoracic deformity surgery