Pilegaard Hans K, Licht Peter B
Department of Cardiothoracic Surgery, Aarhus University Hospital, Skejby Aarhus, Denmark.
Ann Thorac Surg. 2008 Sep;86(3):952-6. doi: 10.1016/j.athoracsur.2008.04.078.
The Nuss operation, a minimally invasive repair of pectus excavatum, is considered the treatment of choice in children. It is controversial in adults, but smaller series have been published. We have used the Nuss operation routinely in adults since 2003.
The indication for operation was a patient-described disabling cosmetic appearance. We modified the operation by using a shorter pectus bar, which appears to be more stable. All patient records were available and analyzed retrospectively.
Operations for pectus excavatum were done in 475 patients (89% men) at Aarhus University Hospital. 180 patients (38%) were aged 18 years or older, median patient age was 22 years (range, 18 to 43 years). All but one patient achieved an excellent cosmetic result. Two pectus bars were required in 57 patients (32%), and 2 patients required 3 pectus bars. The median duration of the procedure was 41 minutes (range, 16 to 119 minutes), which was significantly longer compared with younger patients, but the difference was not clinically relevant (6 minutes). Pneumothorax occurred in 86 patients (48%), but only 4 (2%) required chest tube drainage. In 3 patients the pectus bar dislocated during follow-up.
Minimally invasive repair for pectus excavatum can be performed safely in adults, with excellent immediate cosmetic results. Adults often require more than 1 pectus bar. From the results of this large series, we conclude that patients aged younger than 50 years are eligible for minimally invasive surgical correction of pectus excavatum.
努斯手术是漏斗胸的一种微创手术，被认为是儿童漏斗胸的首选治疗方法。该手术在成人中的应用存在争议，但已有少量相关系列报道发表。自2003年以来，我们一直在成人患者中常规使用努斯手术。
手术指征为患者自述外观不佳影响生活。我们通过使用更短的鸡胸矫正钢板对手术进行了改良，这种钢板似乎更稳定。所有患者记录均可供查阅，并进行回顾性分析。
奥胡斯大学医院对475例患者（89%为男性）实施了漏斗胸手术。180例患者（38%）年龄在18岁及以上，患者年龄中位数为22岁（范围为18至43岁）。除1例患者外，所有患者均获得了极佳的美容效果。57例患者（32%）需要使用2块鸡胸矫正钢板，2例患者需要3块鸡胸矫正钢板。手术的中位持续时间为41分钟（范围为16至119分钟），与年轻患者相比明显更长，但差异在临床上不显著（6分钟）。86例患者（48%）发生气胸，但仅4例（2%）需要胸腔闭式引流。3例患者在随访期间鸡胸矫正钢板发生移位。
成人漏斗胸的微创手术可以安全进行，术后即刻美容效果极佳。成人通常需要不止1块鸡胸矫正钢板。从这个大型系列的结果来看，我们得出结论，50岁以下的患者适合接受漏斗胸的微创手术矫正。
