Dzielicki Józef, Korlacki Wojciech, Janicka Irena, Dzielicka Ewa
Department of Pediatric Surgery, Silesian Medical University, Minimally Invasive Surgery Center for Adults and Children, University Hospital No. 1, 3 Maja 13-15, 41-800 Zabrze, Poland.
Eur J Cardiothorac Surg. 2006 Nov;30(5):801-4. doi: 10.1016/j.ejcts.2006.08.004. Epub 2006 Sep 18.
In 1998, Dr Donald Nuss proposed minimally invasive repair of pectus excavatum (MIRPE) which did not require the osteochondrous parts of the anterior chest wall to be resected. The paper aims at presenting the authors' own 6 years of experience in funnel chest repair with MIRPE technique. Also, many technical problems of this method are discussed.
Between 1999 and 2005, 461 patients (99 female and 362 male, aged 3-31 years, mean age 15.2 years) with pectus excavatum were operated with the Nuss technique. All patients were operated-on according to the original operative protocol proposed by Donald Nuss. With growing experience, own modifications were introduced. Insertion of two bars was done in 17.4%, transverse sternotomy in adolescents with rigid anterior chest wall in 7.8%, limited excision of the rib cartilages in 5.9%, and parasternal fixation of the bar to prevent it from rotating in 59.7% of patients.
There were no deaths. Intraoperative complications were noted in 19 (4.1%) patients and postoperative ones were observed in 43 (9.3%) patients. The operative time ranged from 25 to 130 min (52 min on average). In 192 (41.6%) patients, an epidural block was used. The hospital stay ranged from 4 to 12 days with the mean of 5.3 days. A redo procedure for the bar rotation was necessary in 13 (2.8%) patients. The support bar has been removed in 260 (56.4%) patients so far. In all the patients, an adequate contour of the anterior chest wall has been maintained.
MIRPE proposed by Nuss has all the features of a minimally invasive procedure and is straightforward. Better clinical results are achievable in patients under 12 years of age with a symmetric deformity. In older patients (over 15 years of age) with a rigid chest or with an asymmetric deformity, additional procedures are required to achieve a comprehensive correction of the deformity. Recent results and forward clinical observations may give proof to establish MIRPE as a method of choice in funnel chest correction.
1998年，唐纳德·努斯博士提出了漏斗胸微创修复术（MIRPE），该手术无需切除前胸壁的骨软骨部分。本文旨在介绍作者自身运用MIRPE技术进行漏斗胸修复的6年经验。同时，还讨论了该方法的诸多技术问题。
1999年至2005年间，461例漏斗胸患者（99例女性，362例男性，年龄3至31岁，平均年龄15.2岁）接受了努斯技术手术。所有患者均按照唐纳德·努斯提出的原始手术方案进行手术。随着经验的积累，引入了自身的改良方法。17.4%的患者插入了两根支撑条，7.8%的前胸壁僵硬的青少年患者进行了胸骨横断术，5.9%的患者对肋软骨进行了有限切除，59.7%的患者采用胸骨旁固定支撑条以防止其旋转。
无死亡病例。19例（4.1%）患者出现术中并发症，43例（9.3%）患者出现术后并发症。手术时间为25至130分钟（平均52分钟）。192例（41.6%）患者使用了硬膜外阻滞。住院时间为4至12天，平均5.3天。13例（2.8%）患者因支撑条旋转需要再次手术。迄今为止，260例（56.4%）患者的支撑条已被取出。所有患者前胸壁均保持了合适的外形。
努斯提出 的MIRPE具备微创手术的所有特点且操作简单。对于12岁以下、畸形对称的患者，可取得更好的临床效果。对于年龄较大（超过15岁）、胸廓僵硬或畸形不对称的患者，则需要额外的手术来实现畸形的全面矫正。近期结果及未来的临床观察可能证明MIRPE可成为漏斗胸矫正的首选方法。
