Department of Thoracic Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China.
J Pediatr Surg. 2013 May;48(5):1137-41. doi: 10.1016/j.jpedsurg.2013.01.052.
Although the Nuss procedure has been widely accepted as the standard procedure for the repair of pectus excavatum in children, adolescents, and even adults, few reports have documented the bar removal procedure as a whole. In this study, we retrospectively evaluated the safety and efficacy of a modified Nuss bar removal procedure.
A total of 186 patients undergoing bar removal after the Nuss procedure were included in this study. All cases had unilateral incision (metallic stabilizers were used on one side in all patients). Patients were laid down in the supine position and given general anesthesia through a single lumen tracheal tube or laryngeal mask. The bar was pulled out along the thoracic wall without straightening or overturning through the original right incision.
The mean operation time for bar removal was 12 min (range: 8-20 min). The mean operative blood loss was 5 mL (range: 3-20 mL). No patient suffered from an infection at the incision after surgery, but 3 patients (1.6%) developed mild pneumothorax. All patients were discharged from the hospital within a day after the surgery. The bar in 133 patients (71.5%) was removed in 2 years after Nuss procedure but more than two and a half years in 53 patients (28.5%). The patients were followed up for 4 to 48 months with a mean of 21.4 months. No recurrence was observed during the follow-up period.
The Nuss bar can be safely and easily removed in 2 years or longer after the Nuss procedure. Our study suggests that, after removing the metallic stabilizer, the bar should be turned with the flipper to loosen it from the surrounding fibrous capsule and then pulled out along the original surgical incision without bending or turning.
虽然 Nuss 手术已被广泛接受为儿童、青少年甚至成人漏斗胸修复的标准手术，但很少有文献全面记录该手术的移除过程。在本研究中，我们回顾性评估了改良 Nuss 手术移除过程的安全性和有效性。
共纳入 186 例行 Nuss 手术后接受移除术的患者。所有患者均采用单侧切口（所有患者的一侧使用金属稳定器）。患者仰卧位，通过单腔气管导管或喉罩全身麻醉。通过原始右侧切口，无需拉直或翻转，沿胸壁将支撑杆拔出。
移除支撑杆的平均手术时间为 12 分钟（范围：8-20 分钟）。平均手术出血量为 5 毫升（范围：3-20 毫升）。术后无患者切口感染，但 3 例（1.6%）发生轻度气胸。所有患者术后 1 天内出院。133 例（71.5%）患者在 Nuss 手术后 2 年内移除支撑杆，53 例（28.5%）患者超过 2 年半。患者平均随访 21.4 个月（4-48 个月）。随访期间未观察到复发。
Nuss 手术后 2 年或更长时间，支撑杆可以安全、轻松地移除。我们的研究表明，在移除金属稳定器后，应使用翻转器转动支撑杆，使其从周围纤维囊中松动，然后沿原始手术切口沿胸壁拔出，无需弯曲或翻转。
