Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
J Pediatr Surg. 2010 Jan;45(1):200-5. doi: 10.1016/j.jpedsurg.2009.10.036.
BACKGROUND/PURPOSE: Despite success of several techniques described for pectus excavatum repair, a minority of patients require multiple reoperations for recurrence or other complications. We aimed to review our experience in reoperative pectus excavatum repairs and to identify features correlating with need for additional reoperations.
Charts were reviewed of all patients undergoing reoperative pectus excavatum repair for 3 years at a university-based children's hospital. Number and type of previous repairs, time between operations, lengths of stay, analgesia, and complications were recorded.
From February 2004 to December 2007, 170 pectus excavatum repairs were performed. Among these, 27 were reoperative. Overall, 18.2% of reoperative patients required subsequent additional reoperations. 21.1% of patients undergoing repeat open repairs and 33.3% of patients undergoing repeat minimally invasive repairs required further operative interventions. There was no need for additional repairs among patients who had open repairs after minimally invasive repairs, nor for any patients who had minimally invasive repairs after open repairs.
We conclude that patients with failed open repairs will have better success with minimally invasive reoperations, whereas patients with failed minimally invasive repairs will have better success with open reoperations. When faced with reoperative pectus excavatum, we recommend consideration of an alternative operative approach from the initial procedure.
背景/目的：尽管已经有多种技术被描述用于修复漏斗胸，但仍有少数患者因复发或其他并发症需要多次手术。我们旨在回顾我们在漏斗胸修复再手术中的经验，并确定与需要额外手术相关的特征。
回顾了 3 年来在一所大学附属儿童医院接受漏斗胸修复再手术的所有患者的病历。记录了先前手术的次数和类型、手术间隔时间、住院时间、镇痛和并发症。
从 2004 年 2 月至 2007 年 12 月，共进行了 170 例漏斗胸修复术，其中 27 例为再手术。总体而言，18.2%的再手术患者需要进一步手术干预。21.1%接受重复开放修复的患者和 33.3%接受重复微创修复的患者需要进一步手术干预。微创修复后再行开放修复的患者和开放修复后再行微创修复的患者均无需进一步修复。
我们得出结论，对于初次手术为开放修复失败的患者，微创再手术的成功率更高，而对于初次手术为微创修复失败的患者，开放再手术的成功率更高。当面对漏斗胸修复再手术时，我们建议考虑从初始手术中采用另一种手术方法。
