Yüksel Mustafa, Özalper Mehmet Hakan, Bostanci Korkut, Ermerak Nezih Onur, Cimşit Çagatay, Tasali Nuri, Yildizeli Bedrettin, Fevzi Batirel Hasan
Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey.
Interact Cardiovasc Thorac Surg. 2013 Sep;17(3):571-5. doi: 10.1093/icvts/ivt255. Epub 2013 Jun 19.
Minimally invasive repair of pectus excavatum, the so-called Nuss procedure, has become a popular technique in recent years. The internal mammary arteries (IMAs) lie on the posterolateral surface of the sternum, and the Nuss bar is likely to obstruct the blood flow in these arteries. This obstruction could become important in the later stages of the lives of these young people if they were to require coronary artery bypass grafting. The goal of this study is to investigate the extent of obstruction of the IMAs caused by Nuss bars.
Data were collected prospectively on all patients who underwent the Nuss procedure between October 2011 and May 2012. Patients with a history of pectus excavatum repair by open surgery and those who were younger than 16 years of age were excluded. Computed tomography-angiography (CTA) was performed for the detection of IMA blood flow preoperatively and on the 10th postoperative day. Blood flow in the IMAs was evaluated blindly by two radiologists and classified as blood flow unaffected (group I) or affected (group II) by comparing the assessment of preoperative and postoperative CTAs. The patients in group II were also categorized as having blood flow obstructed bilaterally, blood flow obstructed unilaterally and others (diminished unilaterally/diminished on one side or obstructed on the other side).
Thirty-four patients (31 male and three female; mean age 20.7 ± 4.2 years) underwent surgery. Blood flow was affected in 15 patients (44%), with bilateral obstruction in five, unilateral obstruction in seven, and unilateral diminished flow in two patients. In one patient, blood flow was diminished on one side and obstructed on the other. There was no significant difference between unaffected group I patients and affected group II patients in terms of sex, age, type of deformity, Haller index and the number of bars placed.
Nuss bars cause pressure on the IMAs, but a risk factor for this effect could not be identified. This is a relatively common clinical consequence of minimally invasive repair of pectus excavatum, and the long-term effects will be apparent following bar removal.
漏斗胸微创修复术，即所谓的努斯手术，近年来已成为一种流行的技术。胸廓内动脉（IMAs）位于胸骨后外侧表面，努斯棒可能会阻碍这些动脉的血流。如果这些年轻人日后需要冠状动脉搭桥手术，这种阻碍在他们生命的后期可能会变得很重要。本研究的目的是调查努斯棒对胸廓内动脉的阻碍程度。
前瞻性收集2011年10月至2012年5月期间所有接受努斯手术的患者的数据。排除有开放手术修复漏斗胸病史的患者以及年龄小于16岁的患者。术前及术后第10天进行计算机断层扫描血管造影（CTA）以检测胸廓内动脉血流。两名放射科医生对胸廓内动脉血流进行盲法评估，并通过比较术前和术后CTA的评估结果将其分类为血流未受影响（I组）或受影响（II组）。II组患者还被分类为双侧血流受阻、单侧血流受阻和其他情况（单侧血流减少/一侧血流减少或另一侧血流受阻）。
34例患者（31例男性，3例女性；平均年龄20.7±4.2岁）接受了手术。15例患者（44%）的血流受到影响，其中5例双侧受阻，7例单侧受阻，2例单侧血流减少。1例患者一侧血流减少，另一侧血流受阻。I组未受影响患者和II组受影响患者在性别、年龄、畸形类型、哈勒指数和放置的棒数量方面无显著差异。
努斯棒对胸廓内动脉造成压迫，但无法确定这种影响的危险因素。这是漏斗胸微创修复术相对常见的临床后果，取出棒后长期影响将显现出来。
