与 Nuss 手术相关的并发症：通过手术技术将风险最小化。

Complications related to the Nuss procedure: minimizing risk with operative technique.

机构信息

Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.

出版信息

J Pediatr Surg. 2013 May;48(5):1044-8. doi: 10.1016/j.jpedsurg.2013.02.025.

DOI:10.1016/j.jpedsurg.2013.02.025

PMID:23701780

Abstract

INTRODUCTION

Pectus Excavatum (PEx) is the most frequent congenital chest wall deformity; surgical correction has a complication rate of 10%-50%. The purpose of this study was to evaluate outcomes in a recent cohort of pediatric patients from a single institution and investigate factors associated with complications.

METHODS

A review of all patients with PEx treated with a Nuss procedure from 2003 to 2011 was performed. Complications included hemo/pneumothorax, infection, bar migration, and operative injury. Chi-square, Student's t-test, and logistic regression were performed.

RESULTS

The study included 127 Nuss patients with a the median age of 15.2 years (5.4-18.7) and a mean Haller index of 4.2 (+1.6). The total complication rate was 26% and bar migration rate was 18%. The use of a stabilizer was associated with fewer overall complications (17% vs 41%,p=0.006), decreased reoperation (16% vs 41%,p=0.003), decreased readmission (15% vs 39%,p=0.004), and decreased bar migration rate (9% vs 36%,p=0.001) compared to patients without a stabilizer. On multivariate analysis, the use of a stabilizer (OR 0.18,p=0.011,95% CI 0.049-0.68) and the use of a pericostal suture (OR 0.19,p=0.03,95% CI 0.41-0.85) were associated with decreased rates of bar migration.

CONCLUSION

The use of a lateral stabilizer and pericostal sutures decreased complication and reoperation rates for the Nuss procedure.

摘要

简介

漏斗胸（PEx）是最常见的先天性胸廓畸形；手术矫正的并发症发生率为 10%-50%。本研究的目的是评估单中心近期一组儿科患者的治疗结果，并探讨与并发症相关的因素。

方法

对 2003 年至 2011 年间接受 Nuss 手术治疗的所有 PEx 患者进行回顾性分析。并发症包括血/气胸、感染、矫正器移位和手术损伤。采用卡方检验、Student's t 检验和逻辑回归进行分析。

结果

研究纳入 127 例接受 Nuss 手术的患者，中位年龄为 15.2 岁（5.4-18.7），Haller 指数均值为 4.2（+1.6）。总并发症发生率为 26%，矫正器移位率为 18%。使用稳定器与总体并发症减少相关（17% vs 41%，p=0.006），降低了再次手术率（16% vs 41%，p=0.003）、再入院率（15% vs 39%，p=0.004）和矫正器移位率（9% vs 36%，p=0.001）。多变量分析显示，使用稳定器（OR 0.18，p=0.011，95%CI 0.049-0.68）和使用肋旁缝线（OR 0.19，p=0.03，95%CI 0.41-0.85）与矫正器移位率降低相关。