Sacco Casamassima Maria Grazia, Gause Colin, Goldstein Seth D, Karim Omar, Swarup Abhishek, McIltrot Kimberly, Yang Jingyan, Abdullah Fizan, Colombani Paul M
Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
Ann Thorac Surg. 2016 Apr;101(4):1338-45. doi: 10.1016/j.athoracsur.2015.09.102. Epub 2016 Jan 12.
Extensive literature has proved that the Nuss procedure leads to permanent remodeling of the chest wall in pediatric patients with pectus excavatum (PE). However, limited long-term follow-up data are available for adults. Herein, we report a single-institution experience in the management of adult PE with the Nuss procedure, evaluating long-term outcomes and overall patient satisfaction after bar removal.
Adult patients who underwent PE repair with a modified Nuss procedure between January 1998 and June 2011 were retrospectively identified. Outcomes of interest were postoperative pain, recurrence, and patient satisfaction. A modified single-step Nuss questionnaire was administered to evaluate patient satisfaction and quality-of-life improvement after PE repair.
Ninety-eight patients with a median age of 30.9 years (range, 21.8 to 55.1 years) at the time of repair were identified. One bar was placed in most patients (89.7%). Four patients (4.1%) required reoperation for bar displacement. Results after bar removal were overall satisfactory in 94.4% of patients; 2 patients required reoperation for recurrence. Thirty-nine patients participated in the survey. Satisfaction with chest appearance was reported by 89.7% of responders. Seven patients reported dissatisfaction with the overall results; the most common complaints were severe postoperative chest pain and dissatisfaction with surgical scars.
Favorable long-term results can be achieved with the Nuss procedure in adults. However, postoperative pain may require a more aggressive analgesic regimen, and it may be the overriding factor in the patient's perception of the quality of the postoperative course.
大量文献已证明，对于小儿漏斗胸（PE）患者，努斯手术可导致胸壁永久性重塑。然而，关于成人患者的长期随访数据有限。在此，我们报告在一家机构采用努斯手术治疗成人PE的经验，评估取出钢板后的长期疗效和患者总体满意度。
回顾性确定1998年1月至2011年6月期间接受改良努斯手术治疗PE的成年患者。关注的结果包括术后疼痛、复发和患者满意度。采用改良的单步努斯问卷评估PE修复术后患者的满意度和生活质量改善情况。
确定了98例修复时中位年龄为30.9岁（范围21.8至55.1岁）的患者。大多数患者（89.7%）放置了一根钢板。4例患者（4.1%）因钢板移位需要再次手术。取出钢板后的结果在94.4%的患者中总体令人满意；2例患者因复发需要再次手术。39例患者参与了调查。89.7%的受访者表示对胸部外观满意。7例患者报告对总体结果不满意；最常见的抱怨是术后严重胸痛和对手术疤痕不满意。
努斯手术在成人中可取得良好的长期效果。然而，术后疼痛可能需要更积极的镇痛方案，并且它可能是患者对术后过程质量认知的首要因素。
