Balci Akin Eraslan, Eren Sevval, Ozyurtkan Mehmet Oguzhan
Euphrates University School of Medicine, Department of Thoracic Surgery, Elaziğ, Turkey.
Asian Cardiovasc Thorac Ann. 2013 Dec;21(6):683-8. doi: 10.1177/0218492312467538. Epub 2013 Jul 9.
The indications for repair of pectus excavatum are controversial. We present our surgical results in children with severe pectus excavatum.
27 children aged 6-15-years were included in the study. Pulmonary function tests and chest measurements were performed pre- and postoperatively. Deformed cartilages were resected subperichondrially, and a Kirchner wire was used to support the chest cage; it was removed 5 days after the operation. Fourteen children with restricted pulmonary function were considered to have excessive pectus excavatum.
3 patients had asthma-like symptoms that resolved postoperatively. None suffered chest pain postoperatively. Postoperative hospital stay was 7.1 days. Only minor complications occurred postoperatively. The mean pectus severity index was 0.27 ± 0.2 preoperatively and 0.41 ± 0.1 postoperatively (p < 0.05). For children with restricted pulmonary function, it was 0.17 ± 0.3 preoperatively and 0.38 ± 0.2 postoperatively (p < 0.05). Mean percentage of predicted forced expiratory volume in 1 s changed significantly from 79.2% ± 17.8% preoperatively to 83.6% ± 12.2% by the 3rd postoperative month. For children with a pectus severity index <0.2, it changed from 68.5% ± 13.2% preoperatively to 82.3% ± 13.4%. Pulmonary restriction correlated with a worse pectus severity index (r = 0.8). After 6 and 13 months, a minor decrease in pulmonary function was noted. Significant increases in right and left ventricular function occurred in cases of severe deformity.
Surgery is recommended not only for cosmetic reasons but also to increase cardiorespiratory functional capacity and alleviate symptoms. Kirchner wires can be used safely.
漏斗胸修复术的适应症存在争议。我们展示了我们对重度漏斗胸患儿的手术结果。
27名年龄在6至15岁的儿童纳入本研究。术前和术后均进行了肺功能测试和胸部测量。在软骨膜下切除变形软骨，并用克氏针支撑胸廓；术后5天取出。14名肺功能受限的儿童被认为漏斗胸过度。
3例患者有哮喘样症状，术后缓解。术后无胸痛。术后住院时间为7.1天。术后仅发生轻微并发症。术前平均漏斗胸严重指数为0.27±0.2，术后为0.41±0.1（p<0.05）。对于肺功能受限的儿童，术前为0.17±0.3，术后为0.38±0.2（p<0.05）。术后第3个月，预计1秒用力呼气量的平均百分比从术前的79.2%±17.8%显著变化至83.6%±12.2%。对于漏斗胸严重指数<0.2的儿童，该指标从术前的68.5%±13.2%变化至82.3%±13.4%。肺功能受限与更严重的漏斗胸严重指数相关（r = 0.8）。6个月和13个月后，观察到肺功能有轻微下降。严重畸形病例的左右心室功能显著增加。
推荐手术不仅是出于美容原因，也是为了提高心肺功能能力并缓解症状。克氏针可安全使用。
