Engum S, Rescorla F, West K, Rouse T, Scherer L R, Grosfeld J
Section of Pediatric Surgery, Indiana University School of Medicine, and the James Whitcomb Riley Hospital for Children, Indianapolis, USA.
J Pediatr Surg. 2000 Feb;35(2):246-51; discussion 257-8. doi: 10.1016/s0022-3468(00)90018-6.
BACKGROUND/PURPOSE: Minimal access surgery (MIS, Nuss Procedure) is gaining acceptance rapidly as the preferred method for pectus excavatum repair. This shift in operative management has followed a single institution's evaluation of the procedure. This report describes an additional experience with the Nuss procedure.
Twenty-one patients with pectus excavatum underwent repair by the Nuss Procedure. The patients ranged in age from 5 to 15 years (average, 8.2 years). There were 19 boys and 2 girls.
In 1 patient (age 5 years) the MIS procedure was aborted because of persistence of chest wall asymmetry. The other 20 patients had completion of their procedure without intraoperative complication. The operating times ranged from 45 to 90 minutes; however, there was an additional anesthetic set-up time (average, 45 minutes). All cases utilized a single support bar (11 to 17 inches). Patients underwent extubation in the operating room and were admitted to a ward bed with an epidural catheter in place for pain control and received intravenous analgesia. The hospital stay ranged from 4 to 11 days and averaged 4.9 days. Early postoperative complications included ileus (n = 1), bilateral pleural effusion (n = 2), atelectasis (n = 1), fungal dermatitis (n = 1), pneumothorax (n = 1), and flipped pectus bar (n = 2). Delayed complications included flipped pectus bar (n = 2), marked pectus carinatum requiring bar removal (n = 1), mild carinatum (n = 1), mild bar deviation (n = 1), progressive chest wall asymmetry (n = 3) with 1 requiring bar removal and open pectus repair, pleural effusion (n = 1), and chronic persistent pain requiring bar removal (n = 1). The length of follow-up is 3 to 20 months with an average of 12.3 months.
The Nuss Procedure is quick, minimally invasive, and a technically easy method to learn; however, our data indicate there is a significant learning curve. Although previous reports suggest that few complications occur, we believe further assessment of patient selection regarding age, presence of connective tissue disorder, and severe chest wall asymmetry are still needed. Long-term follow-up also will be required to assure both health professionals and the public that this is the procedure of choice for patients with pectus excavatum.
背景/目的：微创外科手术（MIS，努氏手术）作为漏斗胸修复的首选方法正在迅速得到认可。这种手术管理方式的转变是基于单一机构对该手术的评估。本报告描述了努氏手术的更多经验。
21例漏斗胸患者接受了努氏手术修复。患者年龄在5至15岁之间（平均8.2岁）。其中19例为男性，2例为女性。
1例患者（5岁）因胸壁不对称持续存在，微创外科手术中止。其他20例患者手术顺利完成，无术中并发症。手术时间为45至90分钟；不过，还有额外的麻醉准备时间（平均45分钟）。所有病例均使用单根支撑棒（11至17英寸）。患者在手术室拔管，带着硬膜外导管被送入病房床，用于控制疼痛，并接受静脉镇痛。住院时间为4至11天，平均4.9天。术后早期并发症包括肠梗阻（1例）、双侧胸腔积液（2例）、肺不张（1例）、真菌性皮炎（1例）、气胸（1例）和支撑棒翻转（2例）。延迟并发症包括支撑棒翻转（2例）、明显鸡胸需要取出支撑棒（1例）、轻度鸡胸（1例）、支撑棒轻度偏移（1例）、进行性胸壁不对称（3例），其中1例需要取出支撑棒并进行开放性漏斗胸修复、胸腔积液（1例）和慢性持续性疼痛需要取出支撑棒（1例）。随访时间为3至20个月，平均12.3个月。
努氏手术快速、微创，且技术上易于学习；然而，我们的数据表明存在显著的学习曲线。尽管先前的报告表明并发症很少发生，但我们认为仍需要进一步评估患者选择，包括年龄、结缔组织疾病的存在以及严重胸壁不对称情况。还需要长期随访，以向医疗专业人员和公众保证这是漏斗胸患者的首选手术方法。
