Rokitansky Alexander M, Stanek Rainer
Pneumologia. 2013 Oct-Dec;62(4):224-31.
In order to achieve safe and successful funnel chest treatment even in older patients and reduce postoperative complications, we modified the procedure of minimally invasive pectus repair using the single-piece pectus bar (PSI Hofer Medical, Austria) with no metal abrasion. The features of modified minimally invasive funnel chest correction (MMIPR) are the following: (a) additional subxiphoidal incision, (b) anterior mediastinal-mediastinoscopic mobilization, (c) mediastinoscopy, (d) elevation of the funnel during pectus bar placement, and (e) fixation of the implant ends in a latissimus dorsi muscle bag, below the anterior margin of the muscle. In older funnel chest patients with a stiff thorax, a curved sternum, marked asymmetry or a mixed pigeon/funnel chest, the minimally invasive correction method has to be supplemented by additional surgical measures (MEMIPR) such as partial sternotomy (23%), slit-rib chondrotomy under thoracoscopic guidance (Rokitansky method; 48%), rib resection (5%), and occasionally rib osteotomy. In 8 patients with residual minor deformities we administered an ultrasound-guided Macrolane injection (5 to 20 cc). 262 patients (mean age: 17.7+/-7 years) were eligible for analysis. The large majority of them underwent MIPR between the age of 14 and 20 years; 6 patients were older than 40 years. The pectus bar implant was left in the chest for a period of 1.4 to 6.5 years. Modified minimally invasive pectus repair (MMIPR) was performed in 121 patients (mean age: 15.2+/-5 years). The majority of patients received one pectus bar; 13.2% received two bars. Modified extended minimally invasive pectus repair (MEMIPR) was performed in 141 patients (mean age: 22.5+/-8 years); two pectus bars were used in 58.1% of cases. We observed no bar dislocation. Minimal bar movements were noted in 1.6% (MEMIPR) and 4.9% (MMIPR) of cases. With the MEMIPR technique, subcutaneous hematoma was observed in 4.1% of patients. No re-thoracotomy was required in the 262 patients who underwent MMIPR or MEMIPR. After a mean period of 3.4 years the implants were removed surgically in 103 patients; recurrences were observed 0.9%. Our procedures of MMIPR and MEMIPR with a single-piece pectus bar permitted safe and successful surgery in patients who required complex funnel chest correction.
为了即使在老年患者中也能实现安全、成功的漏斗胸治疗，并减少术后并发症，我们对使用无金属磨损的单件式鸡胸矫正棒（PSI Hofer Medical，奥地利）的微创鸡胸修复手术进行了改良。改良微创漏斗胸矫正术（MMIPR）的特点如下：（a）额外的剑突下切口；（b）前纵隔-纵隔镜下松解；（c）纵隔镜检查；（d）放置鸡胸矫正棒时抬高漏斗；（e）将植入物末端固定在背阔肌肌袋内、肌肉前缘下方。对于胸廓僵硬、胸骨弯曲、明显不对称或混合性鸽胸/漏斗胸的老年漏斗胸患者，微创矫正方法必须辅以额外的手术措施（MEMIPR），如部分胸骨切开术（23%）、胸腔镜引导下的肋骨软骨切开术（罗基坦斯基法；48%）、肋骨切除术（5%），偶尔还需进行肋骨截骨术。在8例残留轻微畸形的患者中，我们进行了超声引导下的聚左旋乳酸注射（5至20毫升）。262例患者（平均年龄：17.7±7岁）符合分析条件。其中大多数患者在14至20岁之间接受了微创鸡胸修复术；6例患者年龄超过40岁。鸡胸矫正棒植入物在胸部留置1.4至6.5年。121例患者（平均年龄：15.2±5岁）接受了改良微创鸡胸修复术（MMIPR）。大多数患者使用一根鸡胸矫正棒；13.2%的患者使用两根。141例患者（平均年龄：22.5±8岁）接受了改良扩大微创鸡胸修复术（MEMIPR）；58.1%的病例使用两根鸡胸矫正棒。我们未观察到矫正棒移位。在1.6%（MEMIPR）和4.9%（MMIPR）的病例中观察到矫正棒有轻微移动。采用MEMIPR技术时，4.1%的患者出现皮下血肿。接受MMIPR或MEMIPR的262例患者均无需再次开胸。平均3.4年后，103例患者通过手术取出植入物；复发率为0.9%。我们采用单件式鸡胸矫正棒的MMIPR和MEMIPR手术方法，使需要复杂漏斗胸矫正的患者能够安全、成功地进行手术。
