Objective To explore the feasibility and efficacy in therapy of pectus excavatum using novel modified Nuss procedure after congenital heart disease (CHD) operation. Methods Thirty-six children (including 22 males and 14 females with an average age of 4.5±2.2 years ranging 2.8-18.0 years) with pectus excavatum after CHD operation from January 2011 to March 2015 were selected as an observation group. Thirty-eight pectus excavatum children (including 24 males and 14 females with an average age of 4.0±2.5 years ranging 2.8-20.0 years) without CHD from July to September 2013 were selected as a control group. The novel modified Nuss procedure was performed on the patients in both groups. The operation time, intraoperative blood loss, hospital stay as well as postoperative complications between two groups were reviewed and analyzed. Results In the observation group, the operation time was 50-72 (60.50±3.60) min and hospital stay was 4-6 (4.41±0.80) d. Meanwhile, the intraoperative blood loss was 5-10 (5.82±0.35) ml. In the control group, the operation time was 12-45 (20.15±0.68) min, hospital stay was 4-7 (4.61±0.63) d and the intraoperative blood loss was 3-8 (4.62±0.28) ml. The operation time was significantly longer in the observation group than that in the control group (P<0.05). But there was no significant difference in intraoperative blood loss or hospital stay between the two groups (P>0.05). No cardiac rupture happened in the two groups. Conclusion The novel modified Nuss procedure is safe and feasible for pectus excavatum after CHD operation with optimal outcomes.
ObjectiveTo summarize the experience of treating adult recurrent pectus excavatum without plate turnover.MethodsTwenty-seven patients with recurrent pectus excavatum treated by thoracoscopy-assisted placement without plate turnover from 2010 to 2019 in our hospital were enrolled. There were 23 males and 4 females with the age of 3-29 (12.81±7.79) years at the first operation, and 18-29 (21.74±3.56) years at this operation. Incision of 2-3 cm at bilateral axillary midline of the deepest point of pectus excavatum was made, and an auxiliary incision under xiphoid process was adopted according to the intraoperative situation.ResultsAll patients underwent thoracoscopy-assisted correction of pectus excavatum without bar turnover, and subxiphoid incision was performed in 11 patients. Twenty-five patients had one bar placed, and two patients required two bars. The operation time was 28-45 (33.00±6.44) min. Postoperative Haller index (2.95±0.40) was improved compared with preoperation (4.63±1.03). The postoperative hospital stay was 4-6 (4.00±0.32) day. All patients were followed up for 1-8 years. Complications included poor wound healing in 1 patient, and steel wire fracture and displacement in 1 patient. There was no plate rotation or bar displacement. Fourteen patients removed the bar 29-84 (40.36±13.93) months after the placement. Haller index was improved to 2.43-3.61 (2.86±0.35) during removal of steel plate. Untill June 2020, there was no recurrence of pectus excavatum.ConclusionThe treatment of adult recurrent pectus excavatum without plate turnover is satisfactory, and the protection of intercostal muscle and firm fixation is the key to ensure the success of operation and long-term effects.
Objective To summarize the effectiveness of Nuss procedure by thoracoscopy for correction of pectus excavatum. Methods Between September 2009 and January 2012, 33 patients suffering from pectus excavatum underwent Nuss procedure by thoracoscopy. There were 26 males and 7 females, aged from 3 to 22 years (median, 9 years). There was primary operation in 32 cases and reoperation in 1 case after Ravitch procedure. Twenty-four patients had obvious clinical symptoms. The Haller index ranged from 3.3 to 50.1 (mean, 5.6). According to simplified Park classification, 25 cases were classified as symmetric type, 5 as eccentric type, and 3 as unbalanced type. Results Intercostal muscle tear occurred in 1 case during operation; pleural effusion, pulmonary infection, and thoracic vertebral pain occurred in 1 case, respectively after operation. The operation time ranged from 38 to 89 minutes (mean, 60.9 minutes). The intraoperative blood loss was 8-90 mL (mean, 26.2 mL). The postoperative hospitalization days were 6-12 days (mean, 7.6 days). All patients were followed up 12-39 months (mean, 25.6 months). Electrocardiogram and chest X-ray film showed that cardiac compression was improved, and symptoms alleviated. At the last follow-up, according to the Nuss standard, the results were excellent in 27 cases, good in 3 cases, and fair in 3 cases, with an excellent and good rate of 90.9%. There was no significant difference in results of effectiveness evaluation among less than 6 years, 6-12 years, and more than 12 years groups (Z= — 1.751, P=0.109). Conclusion Nuss procedure by thoracoscopy has the advantages of little trauma, simple operation, and fast recovery, so it can obtain satisfactory correction of pectus excavatum.
Objective To summarize the early experience of modified Nuss procedure with thoracoscope for repairing pectus excavatum in children. Methods Fiftythree pediatric pectus excavatum were treated by modified Nuss procedure with thoracoscope from June 2004 to July 2006, theage ranged from 2.4 to 16.0 years, the average age was 8.1 years. Thirtysix patients were symmetric pectus excavatum and 17 patients were asymmetric pectus excavatum. Results The operation in all patients were successful, the average blood loss was less than 10ml. Pericardium perforation occurred in 2 earlier patients during the operation, pneumothorax occurred in 6 patients postoperatively,pleural effusion occurred in 3 patients, and all resolved by corresponding treatments. The average hospital length of stay was 5.5 days. All patients had a satisfied deformity correction and no needs of transfusion. The depression was thoroughly corrected in 48 patients, residual depression was less than 20% of preoperative degrees in 5 patients. Therapeutic results evaluation showed excellent in 46 patients and good in 7 patients. All patients were followed up in 1-25 months without any complaints, the activity ability was same as normal children; there were no bar displacement and injury event occurred. The bar had been removed in 1 patient 24 months after surgery who still kept in excellent results. Conclusion Modified Nuss procedure is easy to be performed with minimal invasion and good shortterm results. Thoracoscopic visualization facilitates the safety of this technique. It is recommendable to be tried and extended applied.
Congenital chest deformity is caused by abnormal development of spine or ribs, resulting in sternal depression or protrusion. Pectus carinatum and pectus excavatum are the most common diseases in clinic, which can either be accompanied by other syndromes or exist alone. The genetic factors of congenital thoracic deformity can be related to single gene mutation, polygene mutation and chromosome aberration. Common clinical congenital thoracic deformity with syndromes, such as Marfan syndrome and Noonan syndrome, often have relatively fixed and clear pathogenic genes. The genetic pathogenesis of non-syndromic and independent congenital thoracic malformations is usually diverse, and treatments for syndromic and non-syndromic congenital thoracic deformity are different. Therefore, it is necessary for us to differentiate syndromic and non-syndromic congenital thoracic deformities in basic research, clinical diagnosis and treatment.
ObjectiveTo summarize the clinical experience and investigate the safety and reliability of uniportal procedure for the correction of pectus excavatum (PE). MethodsFrom November 2010 to November 2015, 203 PE patients (164 males, 39 femalzs average age of 5.7±3.0 years, ranging from 2 to 19 years) underwent the correction operation with only single 2 cm incision on right lateral chest. There were 188 patients under 12 years of age and 15 patients above 12 years. According to Park classification, 176 patients were symmetric and 27 were asymmetric. ResultsAll operations were performed successfully. The average operating time was 16.1±5.2 min with a range of 4-65 min and the average postoperative hospital stay was 6.4±1.3 d, ranging from 4-14 d. A single incision was made on the right chest and only one bar was inserted in the patients. Postoperative follow-up was 1-56 months (mean, 27.6 months). There was no complication occurred such as bar turnover, displacement and redepressed sternum. Totally, 84 patients received bar removal procedure. ConclusionIn terms of operation time and surgical trauma, uniportal procedure for PE is superior to Nuss procedure. And there is no significant difference in the safety and effectiveness between two procedures. Uniportal procedure is especially suitable for the treatment of PE children under 12 years of age.
目的總結二次漏斗胸手術經驗。 方法回顧性分析我院2009年1月至2015年9月39例二次漏斗胸手術患者的臨床資料，男31例、女8例，年齡5～27（13.39±7.61）歲，其中心臟手術后11例、Nuss手術后21例、胸骨翻轉術后5例、Ravitch術后2例。單純凹陷畸形33例，合并前凸畸形6例。Haller指數3.3～6.5（4.53±0.31）。對單純凹陷畸形采用改良Nuss手術，對合并前凸畸形采用“三明治”手術治療。 結果本組無死亡病例，多數患者畸形均得到改善，手術時間53～133（79.09±19.13）min，住院時間5～13（7.09±1.90）d。術后并發癥包括皮下氣腫2例、氣胸3例、肺不張1例、胸腔積液1例。隨訪1～45個月，隨訪率94.87%。依據漏斗胸術后評價標準進行評價，效果非常滿意31例，基本滿意7例，不滿意1例。 結論采用特殊的手術方法，可以安全完成二次漏斗胸手術。