Bawazir Osama A, Montgomery Mark, Harder Joyce, Sigalet David L
Department of Surgery, Pediatric General Surgery, Alberta Children's Hospital, Calgary, AB, Canada T2T 5C7.
J Pediatr Surg. 2005 May;40(5):863-7. doi: 10.1016/j.jpedsurg.2005.02.002.
BACKGROUND/PURPOSE: Since the introduction of the closed technique for repair of pectus excavatum, increasing numbers of patients are presenting for surgery. However, controversy exists regarding the effects of repair on long-term cardiopulmonary outcome. This report details the effects over time of closed repair of pectus excavatum on pulmonary function, cardiac function, exercise tolerance, and the patient's perception of appearance and subjective ability to exercise.
All patients undergoing closed repair of pectus excavatum were evaluated prospectively. Preoperative computed tomography scan, static pulmonary function studies, exercise tolerance, and echocardiographic evaluation of cardiac function were done. Studies were repeated at 3 and 21 months post-bar placement, and then 3 months after bar removal.
Pre- and postoperative data were available for an initial 48 patients, with 11 patients completing the full evaluation after bar removal. All measures of pulmonary function including forced expiratory volume in 1 second and forced vital capacity were reduced at 3 months postoperation, with a gradual increase during follow-up; however, pulmonary function remained below normative values for patients without pectus excavatum of similar age. Cardiac function as measured by cardiac output and index was increased at 3 months postoperation and maintained thereafter. Exercise tolerance declined initially and then increased by the 21-month evaluation point and after bar removal. Patients reported a subjective improvement in the ability to exercise immediately after bar insertion.
These results corroborate previous studies which suggested that after closed repair of pectus excavatum there is an immediate subjective improvement in the ability to exercise which is paralleled by an improvement in cardiac output. However, there is an early postoperative decline in pulmonary function which does improve over time; however, this does not reach normal values for similar weight. Further studies are needed to determine whether these results are maintained, or whether after bar removal there is a further improvement in pulmonary status. These results do support the use of the closed repair of pectus excavatum for maintaining and possibly improving cardiopulmonary function in this patient population.
背景/目的：自从引入漏斗胸闭合修复技术以来，接受手术的患者数量不断增加。然而，关于修复对长期心肺结局的影响仍存在争议。本报告详细阐述了漏斗胸闭合修复术随时间推移对肺功能、心功能、运动耐量以及患者外观感知和主观运动能力的影响。
对所有接受漏斗胸闭合修复术的患者进行前瞻性评估。术前进行计算机断层扫描、静态肺功能研究、运动耐量测试以及心功能的超声心动图评估。在放置支撑棒后3个月和21个月，以及取出支撑棒后3个月重复进行上述研究。
最初有48例患者有术前和术后数据，其中11例患者在取出支撑棒后完成了全部评估。所有肺功能指标，包括一秒用力呼气量和用力肺活量，在术后3个月均下降，随访期间逐渐增加；然而，肺功能仍低于同龄无漏斗胸患者的正常范围。以心输出量和心指数衡量的心功能在术后3个月增加，并在此后维持。运动耐量最初下降，然后在21个月评估点及取出支撑棒后增加。患者报告在插入支撑棒后主观运动能力立即有所改善。
这些结果证实了先前的研究，即漏斗胸闭合修复术后运动能力立即有主观改善，同时心输出量也有所改善。然而，术后早期肺功能会下降，不过随时间推移会有所改善；但未达到相似体重患者的正常水平。需要进一步研究来确定这些结果是否能维持，或者取出支撑棒后肺功能是否会进一步改善。这些结果确实支持在该患者群体中使用漏斗胸闭合修复术来维持并可能改善心肺功能。
