Kubiak R, Habelt S, Hammer J, Häcker F-M, Mayr J, Bielek J
Department of Paediatric Surgery, University Children's Hospital (UKBB), Basel, Switzerland.
Eur J Pediatr Surg. 2007 Aug;17(4):255-60. doi: 10.1055/s-2007-965060.
Pulmonary function testing remains part of the routine preoperative investigations in patients with pectus excavatum, although there is evidence that reduced exercise capacity is predominantly due to impaired cardiovascular performance rather than ventilatory limitation.
To evaluate the change of pulmonary function in patients after completion (metal bar removal) of minimally invasive repair for pectus excavatum compared to the preoperative functional results.
All patients who underwent minimally invasive repair for pectus excavatum (MIRPE) between February 2000 and June 2006 and subsequently had their metal bars removed were examined. Pulmonary function tests were performed as part of the routine pre- and postoperative protocol. Vital capacity (VC), forced expiratory volume in one second (FEV1), total lung capacity (TLC), residual volume (RV) and maximal expiratory flow rate at 25 % (MEF25) were evaluated. In addition, comparisons were made between patients with a low (<or= 6) and those with a high (> 6) pectus severity index (PSI) to establish the relative pre- to postoperative change of the above-mentioned lung function parameters.
Fifteen patients were included in the study (14 males, 1 female). The median age at surgery was 15.9 years. The metal bar(s) were removed after a median of 37 months following the initial operation. Lung function tests were performed at a median of 32 days preoperatively and 129 days after completion of the procedure. Preoperative lung function values lay below population averages. The majority of patients had either a restrictive, obstructive or combined pulmonary disorder. Improvement was observed in all lung function parameters after metal bar removal compared to preoperative values and was significant for VC, FEV1 and the RV/TLC ratios. With regard to the severity of the deformity, although not statistically significant, patients with a higher PSI (> 6) appeared to benefit particularly from the operation.
Our findings indicate that pulmonary function improves in patients after completion of minimally invasive repair of pectus excavatum. However, a review of the literature suggests that, in all probability, following surgery, patients benefit more with regard to enhanced cardiovascular performance than from improved pulmonary limitations. The value of routine testing of pre- and postoperative lung function in patients with pectus excavatum is questionable.
尽管有证据表明运动能力下降主要是由于心血管功能受损而非通气受限，但肺功能测试仍是漏斗胸患者术前常规检查的一部分。
评估漏斗胸微创修复术完成（取出金属棒）后患者的肺功能变化，并与术前功能结果进行比较。
对2000年2月至2006年6月间接受漏斗胸微创修复术（MIRPE）且随后取出金属棒的所有患者进行检查。肺功能测试作为术前和术后常规方案的一部分进行。评估肺活量（VC）、一秒用力呼气容积（FEV1）、肺总量（TLC）、残气量（RV）和25%最大呼气流量（MEF25）。此外，对漏斗胸严重程度指数（PSI）低（≤6）和高（>6）的患者进行比较，以确定上述肺功能参数术前至术后的相对变化。
15例患者纳入研究（14例男性，1例女性）。手术时的中位年龄为15.9岁。初次手术后中位37个月取出金属棒。肺功能测试在术前中位32天和手术完成后129天进行。术前肺功能值低于人群平均水平。大多数患者存在限制性、阻塞性或混合性肺部疾病。与术前值相比，取出金属棒后所有肺功能参数均有改善，VC、FEV1和RV/TLC比值改善显著。关于畸形严重程度，尽管无统计学意义，但PSI较高（>6）的患者似乎从手术中获益尤其明显。
我们的研究结果表明，漏斗胸微创修复术完成后患者的肺功能有所改善。然而，文献综述表明，手术后患者在心血管功能增强方面的获益很可能超过肺功能受限改善方面的获益。对漏斗胸患者术前和术后肺功能进行常规检测的价值值得怀疑。
