Eastern Virginia Medical School Department of Surgery, Norfolk, VA, USA.
J Pediatr Surg. 2011 Jun;46(6):1177-81. doi: 10.1016/j.jpedsurg.2011.03.048.
Controversy exists as to the best operative approach to use in patients with failed pectus excavatum (PE) repair. We examined our institutional experience with redo minimally invasive PE repair along with the unique issues related to each technique.
We conducted an institutional review board-approved review of a prospectively gathered database of all patients who underwent minimally invasive repair of PE.
From June 1987 to January 2010, 100 patients underwent minimally invasive repair for recurrent PE. Previous repairs included 42 Ravitch (RAV) procedures, 51 Nuss (NUS) procedures, 3 Leonard procedures, and 4 with previous NUS and RAV repairs. The median Haller index at reoperation was 4.99 (range, 2.4-20). Fifty-five percent of RAV patients and 25% of NUS patients required 2 or more bars (P = .01). Two RAV patients had intraoperative nonfatal cardiac arrest owing to thoracic chondrodystrophy--1 at insertion and 1 upon removal. Bar displacements occurred in 12% RAV and 7.8% NUS patients (P = .05). Overall reoperation for bar displacement is 9%.
The minimally invasive NUS technique is safe and effective for the correction of recurrent PE. Patients with prior NUS repair can have extensive pleural adhesions necessitating decortication during secondary repair. Patients with a previous RAV repair may have acquired thoracic chondrodystrophy that may require a greater number of pectus bars to be placed at secondary repair and greater risk for complications. We have a greater than 95% success rate regardless of initial repair technique.
对于患有漏斗胸（PE）修复失败的患者，哪种手术入路最佳存在争议。我们检查了我们机构使用微创 PE 修复的经验，以及与每种技术相关的独特问题。
我们对所有接受微创 PE 修复的患者进行了机构审查委员会批准的前瞻性收集数据库审查。
1987 年 6 月至 2010 年 1 月，100 例患者接受微创修复复发性 PE。先前的修复包括 42 例 Ravitch（RAV）手术、51 例 Nuss（NUS）手术、3 例 Leonard 手术和 4 例先前 NUS 和 RAV 修复。再次手术时的中位数 Haller 指数为 4.99（范围 2.4-20）。55%的 RAV 患者和 25%的 NUS 患者需要 2 个或更多的棒（P =.01）。2 例 RAV 患者在术中因胸肋软骨发育不良导致非致命性心脏骤停，1 例在插入时，1 例在取出时。12%的 RAV 患者和 7.8%的 NUS 患者发生棒移位（P =.05）。RAV 患者和 NUS 患者因棒移位再次手术的总体比例分别为 9%。
微创 NUS 技术是治疗复发性 PE 的安全有效方法。有先前 NUS 修复的患者可能有广泛的胸膜粘连，在二次修复时需要进行去皮质化。有先前 RAV 修复的患者可能患有获得性胸肋软骨发育不良，这可能需要在二次修复时放置更多的胸肋软骨发育不良棒，并增加并发症的风险。无论最初的修复技术如何，我们的成功率都超过 95%。
