Chen Zhenguang, Amos Ela Bella, Luo Honghe, Su Chunhua, Zhong Beilong, Zou Jianyong, Lei Yiyan
Department of Thoracic Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
J Cardiothorac Surg. 2012 Sep 29;7:101. doi: 10.1186/1749-8090-7-101.
Pectus excavatum (PE) is a common chest wall malformation, with surgery being the only method known to correct the defect. Although the Nuss and Ravitch procedures are commonly used, there is no consensus as to whether surgical repair improves pulmonary function. We therefore investigated whether pulmonary function recovers after surgical repair, and if recovery is dependent on the type of procedure or time after surgery.
Literature searches were performed using PubMed, EMBASE, Health Periodicals Database, and CNKI (Chinese National Knowledge Index) from January 1990 to December 2007. The following keywords were used: pectus excavatum, chest wall deformity, funnel chest, pulmonary function, respiratory, lung function, and pectus severity index. The primary outcome of interest was possible changes in pulmonary function following surgical repair.
Meta-analysis of 23 studies showed that, although there was evidence of statistically significant heterogeneity among studies (Chi-square, 17.11, p < 0.05), changes in pulmonary functional indices, including forced expiratory volume over 1 s (FEV1), forced vital capacity (FVC), vital capacity (VC), and total lung capacity (TLC), were similar 1 year after the Ravitch and Nuss procedures. Several years after surgery and bar removal, however, the changes in pulmonary functional indices significantly favored the Nuss procedure.
Pulmonary function tends to improve after the surgical correction of pectus excavatum. Although the Nuss procedure was not significantly better 1 year after surgery, long-term postoperative pulmonary function improvement was significantly better after bar removal.
漏斗胸（PE）是一种常见的胸壁畸形，手术是已知纠正该缺陷的唯一方法。尽管常用Nuss手术和Ravitch手术，但对于手术修复是否能改善肺功能尚无共识。因此，我们研究了手术修复后肺功能是否恢复，以及恢复是否取决于手术方式或术后时间。
使用PubMed、EMBASE、健康期刊数据库和中国知网（CNKI）对1990年1月至2007年12月的文献进行检索。使用了以下关键词：漏斗胸、胸壁畸形、漏斗胸、肺功能、呼吸、肺功能和漏斗胸严重程度指数。感兴趣的主要结果是手术修复后肺功能可能的变化。
对23项研究的荟萃分析表明，尽管各研究间存在统计学显著异质性的证据（卡方检验，17.11，p<0.05），但在Ravitch手术和Nuss手术后1年，包括1秒用力呼气量（FEV1）、用力肺活量（FVC）、肺活量（VC）和肺总量（TLC）在内的肺功能指标变化相似。然而，在手术和取出钢板数年之后，肺功能指标的变化明显有利于Nuss手术。
漏斗胸手术矫正后肺功能往往会改善。尽管Nuss手术在术后1年并无显著优势，但术后长期肺功能改善在取出钢板后明显更好。
