漏斗胸の患児に対するNuss procedure（minimally invasive repair of pectus excavatum：MIRPE）の短期治療成績

Nuss Procedure for Pectus Excavatum

　【目的】われわれの行ったNuss procedure（minimally invasive repair of pectus excavatum：MIRPE）の工夫と合併症について検討する．【対象】9例（1〜9歳）．Funnel indexは0.2（0.16〜0.25）であった．【手術】胸腔鏡を用い手術を施行した．工夫としては，最頂点を経皮的に23Gの注射針で穿刺した．胸腔鏡下に確認し，鉗子を胸腔内に挿入した．また，胸骨下縁を単鋭鉤で挙上させ胸骨後面のスペースを広げbarを挿入，回転させた．【結果】手術時間は平均138分であった．気胸開始直後，SpO₂の低下，EtCO₂の上昇を認めた．疼痛対策には硬膜外麻酔と坐薬を併用した．早期合併症は，無気肺を3例に，上部消化管出血を1例に，晩期合併症は創感染，血胸を各1例に認めた．気管軟化症の患児は，胸骨の挙上により症状は消失した．【おわりに】本術式は手術の侵襲，整容的な面からも優れている．

To facilitate the Nuss method for pectus excavatum, we devised some procedures. and assessed them. Nine patients, one to nine years old, were included in this study. Their Funnel index ranged between 0.16 and 0.26, with average 0.2. Principally original Nuss's method was performed. In the supine position, a horizontal line was drawn running through the nadir. After the thoracoscope was inserted, the highest point on the line was punc-tured with a fine needle to identify the proper point from inside on both sides. A tiny incision was made just over the xyphoid, and it was elevated with a hook to make good retrosternal space.