Nuss D, Croitoru D P, Kelly R E, Goretsky M J, Nuss K J, Gustin T S
Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
Eur J Pediatr Surg. 2002 Aug;12(4):230-4. doi: 10.1055/s-2002-34485.
To review and discuss the complications of minimally invasive pectus excavatum repair.
329 patients underwent minimally invasive pectus repair between January 1987 and August 2000, including 14 patients who recurred after previous Ravitch repairs, 10 failed Nuss repairs (eight done elsewhere) and two failed Leonard repairs. All patients received antibiotics and vigorous incentive spirometry to prevent atelectasis, pneumonia and bar infection. Epidural anesthesia was used for postoperative analgesia to keep patients comfortable and stable postoperatively and to prevent bar displacement. Thoracoscopy was used during bar insertion to minimize the risk of mediastinal injury and to select the best position for the bar. A new introducer was developed to elevate the sternum before bar insertion. A stabilizing bar was created to minimize bar displacement. The duration of sternal bracing has been increased from two years to three or four years in selected patients.
There were no deaths, no cardiac perforations and no cases of thoracic chondrodystrophy. Pneumothorax with spontaneous resolution occurred in 52 % of the patients, with 1.2 % requiring simple aspiration and 1.5 % requiring chest tube drainage. This complication has essentially been eliminated by using a "water seal system". Pericarditis occurred in 2.4 % with good response to Indomethacin in six out of eight patients and two patients also required pericardial fluid aspiration. Pneumonia occurred in 0.9 %. Wound infection occurred in 2.6 % resulting in bar infection in three out of the seven patients. Long-term antibiotics were successful in curing the infection in one patient, whereas the other two required bar removal at 12 and 18 months, respectively. Bar displacement occurred in 8.8 % of patients. However, the introduction of stabilizers decreased the incidence from 15.7 % before the use of stabilizers to 5.4 % with stabilizers. Wiring the bar and stabilizer together has decreased the incidence even further.
Long-term outcome after bar removal showed an excellent result in 71 %, good result in 21 % and recurrence in 7.8 %.
The minimally invasive technique has a low complication rate with excellent long-term results.
回顾和讨论微创漏斗胸修复术的并发症。
1987年1月至2000年8月期间，329例患者接受了微创漏斗胸修复术，其中包括14例曾接受过Ravitch修复术但复发的患者、10例Nuss修复术失败的患者（8例在其他地方进行）以及2例Leonard修复术失败的患者。所有患者均接受抗生素治疗并积极进行激励性肺量计训练，以预防肺不张、肺炎和钢板感染。术后采用硬膜外麻醉进行镇痛，以使患者术后舒适、稳定，并防止钢板移位。在插入钢板期间使用胸腔镜，以将纵隔损伤的风险降至最低，并为钢板选择最佳位置。开发了一种新的导引器，以便在插入钢板前抬高胸骨。制作了一个稳定钢板，以尽量减少钢板移位。在部分患者中，胸骨支撑的持续时间已从两年延长至三或四年。
无死亡病例，无心脏穿孔，无胸廓软骨发育不良病例。52%的患者发生了可自行缓解的气胸，1.2%的患者需要简单抽吸，1.5%的患者需要胸腔闭式引流。通过使用“水封系统”，这种并发症基本上已被消除。2.4%的患者发生了心包炎，8例患者中有6例对吲哚美辛反应良好，2例患者还需要心包穿刺抽液。0.9%的患者发生了肺炎。2.6%的患者发生了伤口感染，7例患者中有3例导致钢板感染。长期使用抗生素成功治愈了1例患者的感染，而另外2例患者分别在12个月和18个月时需要取出钢板。8.8%的患者发生了钢板移位。然而，稳定器的引入使发生率从使用稳定器前的15.7%降至使用稳定器后的5.4%。将钢板和稳定器连接在一起进一步降低了发生率。
取出钢板后的长期结果显示，71%的患者效果极佳，21%的患者效果良好，7.8%的患者复发。
微创技术并发症发生率低，长期效果良好。
