Lawson M Louise, Mellins Robert B, Tabangin Meredith, Kelly Robert E, Croitoru Daniel P, Goretsky Michael J, Nuss Donald
Center for Pediatric Research, Children's Hospital of The King's Daughters and Eastern Virginia Medical School, Norfolk, VA 23507, USA.
J Pediatr Surg. 2005 Jan;40(1):174-80. doi: 10.1016/j.jpedsurg.2004.09.040.
BACKGROUND/PURPOSE: Patient reports of preoperative exercise intolerance and improvement after surgical repair of pectus excavatum (Pex) have been documented but not substantiated in laboratory studies. This may be because no study has been large enough to determine if pulmonary function tests (PFTs) in the Pex population are significantly different from the normal population, and none has assessed improvement in pulmonary function after Nuss bar removal.
The authors studied PFT results in 408 Pex patients before repair and in a subset of 45 patients after Nuss procedure and bar removal. Significance of differences in percent predicted (using Knudson's equations) was tested using t tests (parametric) or sign tests (nonparametric). Normal was defined as 100% of predicted for forced vital capacity (FVC), forced expired volume in 1 second (FEV1), and forced expiratory flow (FEF25%-75%).
Preoperatively, FVC and FEV1 medians were lower than the normal by 13%, whereas the FEF 25-75 median was lower than normal by 20% (all P < .01). The postoperative group had statistically significant improvement after surgery for all parameters. Patients older than 11 years at the time of surgery had lower preoperative values and larger mean post-bar removal improvement than the younger patients. An older patient with a preoperative FEF25-75 score of 80% of normal would be predicted by these data to have a postoperative FEF25-75 of 97%, indicating almost complete normalization for this function.
These results demonstrate that preoperatively Pex patients as a group have decreased lung function relative to normal patients. After Nuss procedure and bar removal, we show a small but significant improvement in pulmonary function. These results are consistent with patient reports of clinical improvement and indicate the need for more in-depth tests of cardiopulmonary function under exercise conditions to elucidate the mechanism.
背景/目的：已有文献记载漏斗胸（Pex）患者术前运动不耐受及手术修复后症状改善的情况，但实验室研究尚未证实。这可能是因为尚无研究规模足够大到能够确定漏斗胸患者的肺功能测试（PFTs）与正常人群是否存在显著差异，且没有研究评估过取出努氏棒后肺功能的改善情况。
作者研究了408例漏斗胸患者修复术前的PFT结果，以及45例接受努氏手术并取出钢棒后的患者亚组的PFT结果。使用t检验（参数检验）或符号检验（非参数检验）来检验预测百分比差异的显著性（使用克努森方程）。正常定义为用力肺活量（FVC）、1秒用力呼气容积（FEV1）和用力呼气流量（FEF25%-75%）达到预测值的100%。
术前，FVC和FEV1的中位数比正常水平低13%，而FEF 25-75的中位数比正常水平低20%（所有P < 0.01）。术后组所有参数在术后均有统计学意义的改善。手术时年龄大于11岁的患者术前值较低，取出钢棒后平均改善幅度大于年轻患者。根据这些数据预测，一名术前FEF25-75评分为正常水平80%的老年患者术后FEF25-75将达到97%，表明该功能几乎完全恢复正常。
这些结果表明，作为一个群体，漏斗胸患者术前肺功能相对于正常患者有所下降。在进行努氏手术并取出钢棒后，我们发现肺功能有小幅但显著的改善。这些结果与患者临床症状改善的报告一致，表明需要在运动条件下对心肺功能进行更深入的测试以阐明其机制。
