Nuss Donald
Clinical Surgery and Pediatrics, Eastern Virginia Medical School, and Surgical Affairs, Children's Hospital of the King's Daughters, Norfolk, VA 23507, USA.
Jpn J Thorac Cardiovasc Surg. 2005 Jul;53(7):338-44. doi: 10.1007/s11748-005-0047-1.
To review the new technical modifications and results of 668 patients who have had pectus excavatum repair utilizing the minimally invasive technique.
A retrospective chart review was conducted of 668 patients undergoing minimally invasive pectus repair from 1987 through July 2004. Since 1997, a standardized treatment pathway was implemented. Preoperative evaluation included computed tomography (CT) scan, pulmonary function tests, and cardiac evaluations with electrocardiogram and echocardiogram. Indications for operation included at least 2 of the following: progression of the deformity, Haller CT index greater than 3.25, mitral valve prolapse, cardiac compression or displacement, pulmonary function studies that indicate restrictive or obstructive airway disease, previous failed open or minimally invasive pectus repair. Technical and design modifications since 1998 have included routine thoracoscopy, the use of an introducer/dissector for creating the substernal tunnel, elevating the sternum, and routine use of a wired lateral stabilizer and polydioxanone suture (PDS) sutures around the bar and underlying rib to prevent bar displacement. The bar is removed as an outpatient procedure in 2 to 4 years.
In 668 patients undergoing minimally invasive pectus repairs, single bars were used in 78.1% and double in 21.7%. Lateral stabilizers were applied in 99.8% and were wired for further stability in 71%. Bar shifts before the use of stabilizers were 14.3%, which decreased to 4.6% after stabilizers were placed and 0.8% with a wired stabilizer and PDS sutures. Results were excellent in 78.5%, good in 13.1%, fair in 4.7% and failed in 3.7% after more than 1 year post bar removal.
The minimally invasive technique has evolved into an effective method of pectus excavatum repair. Modifications of the technique have reduced complications. Long-term results continue to be excellent.
回顾668例采用微创技术进行漏斗胸修复的患者的新技术改进及结果。
对1987年至2004年7月期间接受微创漏斗胸修复的668例患者进行回顾性病历审查。自1997年起，实施标准化治疗路径。术前评估包括计算机断层扫描（CT）、肺功能测试以及通过心电图和超声心动图进行的心脏评估。手术指征包括以下至少两项：畸形进展、Haller CT指数大于3.25、二尖瓣脱垂、心脏受压或移位、肺功能研究表明存在限制性或阻塞性气道疾病、既往开放性或微创漏斗胸修复失败。自1998年以来的技术和设计改进包括常规胸腔镜检查、使用导入器/解剖器创建胸骨后隧道、抬高胸骨，以及常规使用带线外侧稳定器和聚二氧六环酮缝线（PDS）围绕钢板和下方肋骨以防止钢板移位。钢板在2至4年内作为门诊手术取出。
在668例接受微创漏斗胸修复的患者中，78.1%使用单根钢板，21.7%使用双根钢板。99.8%应用了外侧稳定器，其中71%进行了布线以进一步稳定。在使用稳定器之前，钢板移位率为14.3%，使用稳定器后降至4.6%，使用带线稳定器和PDS缝线后为0.8%。钢板取出1年以上后，78.5%的结果为优，13.1%为良，4.7%为中，3.7%为差。
微创技术已发展成为一种有效的漏斗胸修复方法。技术改进减少了并发症。长期效果仍然优异。
