Willekes C L, Backer C L, Mavroudis C
Department of Surgery, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois 60614, USA.
Ann Thorac Surg. 1999 Feb;67(2):511-8. doi: 10.1016/s0003-4975(99)00015-6.
We reviewed our operative experience and long-term results with repair of pectus excavatum and carinatum deformities through a vertical midline approach, including those cases with simultaneous intracardiac repair.
From 1972 through 1998, 120 children underwent pectus deformity repair. Operative technique used a vertical midline incision with subperichondrial resection of deformed cartilages and an anterior sternal osteotomy. Thirty-five patients had a temporary metal bar for retrosternal support for 6 months; 85 underwent repair without a bar. Patients and parents were asked to assess the outcome after pectus repair as poor, fair, good, or excellent.
There were 94 male and 26 female patients (mean age, 8.4 years; range, 3 to 21 years). There were 111 cases of pectus excavatum and 9 of pectus carinatum. Fourteen children (11.5%) had an associated congenital heart defect; 9 patients had simultaneous pectus and intracardiac repair. One patient was referred for emergent open heart repair and pectus repair after attempted "Nuss" repair resulted in a perforated right atrium, perforated right ventricle, and partially disrupted tricuspid valve apparatus. There were no deaths and only one significant complication, which required a return to the operating room for bleeding. Morbidity was not higher in patients with simultaneous intracardiac repair. Long-term follow-up was established in 83% of patients. Results were classified as excellent in 64 patients (64%), good in 25 (25%), fair in 8 (8%), and poor in 3 (3%). Thirty (86%) of 35 patients with a sternal bar had excellent results versus 34 (52%) of 65 without a bar (p = 0.004); 97% of patients who underwent repair with a sternal bar classified the result as excellent or good.
Long-term results of pectus excavatum and carinatum repair through a vertical midline approach are excellent. Outcome with a temporary sternal bar is superior to outcome without a bar. Concomitant repair of congenital heart defects and pectus deformity may be performed successfully without additional morbidity.
我们回顾了通过垂直中线入路修复漏斗胸和鸡胸畸形的手术经验及长期效果，包括同期进行心脏内修复的病例。
1972年至1998年期间，120例儿童接受了胸壁畸形修复手术。手术技术采用垂直中线切口，对变形软骨进行软骨膜下切除及胸骨前路截骨术。35例患者使用临时金属棒进行胸骨后支撑6个月；85例未使用金属棒进行修复。患者及家长被要求将漏斗胸修复后的结果评估为差、一般、好或优秀。
男性患者94例，女性患者26例（平均年龄8.4岁；范围3至21岁）。漏斗胸111例，鸡胸9例。14例儿童（11.5%）合并先天性心脏病；9例患者同期进行胸壁和心脏内修复。1例患者在尝试“努斯”修复导致右心房穿孔、右心室穿孔及三尖瓣装置部分断裂后，被转诊进行紧急心脏直视修复和胸壁修复。无死亡病例，仅1例严重并发症，需返回手术室止血。同期进行心脏内修复的患者发病率并未更高。83%的患者进行了长期随访。结果分类为优秀的有64例（64%），良好的有25例（25%），一般的有8例（8%），差的有3例（3%）。使用胸骨棒的35例患者中有30例（86%）结果优秀，未使用胸骨棒的65例患者中有34例（52%）结果优秀（p = 0.004）；使用胸骨棒进行修复的患者中有97%将结果分类为优秀或良好。
通过垂直中线入路修复漏斗胸和鸡胸畸形的长期效果良好。使用临时胸骨棒的效果优于不使用胸骨棒的效果。先天性心脏病和胸壁畸形的同期修复可以成功进行，且不会增加发病率。
