Lučenič M, Janík M, Juhos P, Garchar A
Rozhl Chir. 2016 Jan;95(1):25-32.
Pectus excavatum is the most common congenital chest wall deformity. Aproximatelly 1 out of 400 to 1000 newborns are affected by this diagnosis. Surgical correction is indicated in patients that fulfil the indication criteria. The highly modified Ravitch correction (HMRR) and minimally invasive pectus excavatum repair (MIRPE) are by far the most popular methods of correction. MIRPE has been established as the method of choice amongst children. Feasibility of the minimally invasive approach in the funnel chest correction in adult population still remains controversial.
The authors present a retrospective analysis of adult patients treated by MIRPE in their institution. Sixty adult patients with pectus excavatum underwent MIRPE from October 2010 to March 2015. Various parameters were evaluated retrospectively. The effectiveness and safety of both techniques were evaluated with the use of statistical software SPSS® version 21.0 (IBM, USA). Data were evaluated using Student´s t-test or Mann-Whitney U-test for normally and non-normally distributed data, respectively. The comparison of categorical variables between the groups was evaluated by Pearson´s chi-square test. A p value of less than 0.05 was considered statistically significant.
45 men and 15 women underwent MIRPE during the period. Median age in the group was 23 years without any statistically significant difference between males and females (p=0.386). Median Haller index was 3.93 and was slightly higher in women (p= 0.285). Asymmetric deformities were present in 20 patients (33.3%) without any statistically significant difference between the sexes (p=0.206). Median duration of the surgical correction was 73 minutes and was longer in males (p=0.312). Two bars were implanted in 27 patients with no significant difference between the sexes (p=0.454). Complication rate was 25% (15/60) without any significant difference based on the number of implanted bars (p=0.178), sex (p=0.863) or the presence of an asymmetric deformity (p=0.527). Wound seromas with 10% (6/60) were the most common complication. Median postoperative length of stay was 5 days without any significant difference between males and females (p=0.653) and patients with different number of bars implanted (p=0.600). The need for rehospitalisation and reoperation was indicated in 5 patients (8.3%). Allergy to chromium led to bar extraction in 1 patient and 4 patients were treated by V.A.C.® therapy (KCI, USA) because of wound abscess (1) and seroma (3).
Minimally invasive pectus excavatum repair is an effective surgical technique for the treatment of pectus excavatum in adult patients. This technique can be learned and performed safely even without any former experience with this correction in children.
adult patients - MIRPE pectus excavatum.
漏斗胸是最常见的先天性胸壁畸形。每400至1000名新生儿中约有1人受此疾病影响。符合指征标准的患者需进行手术矫正。高度改良的Ravitch矫正术（HMRR）和微创漏斗胸修复术（MIRPE）是目前最常用的矫正方法。MIRPE已成为儿童患者的首选方法。微创方法在成人漏斗胸矫正中的可行性仍存在争议。
作者对其所在机构接受MIRPE治疗的成年患者进行了回顾性分析。2010年10月至2015年3月，60例成年漏斗胸患者接受了MIRPE治疗。对各项参数进行回顾性评估。使用统计软件SPSS® 21.0版（美国IBM公司）评估两种技术的有效性和安全性。分别使用学生t检验或曼-惠特尼U检验对正态分布和非正态分布的数据进行评估。通过Pearson卡方检验评估组间分类变量的比较。p值小于0.05被认为具有统计学意义。
在此期间，45例男性和15例女性接受了MIRPE治疗。该组患者的中位年龄为23岁，男性和女性之间无统计学显著差异（p = 0.386）。中位Haller指数为3.93，女性略高（p = 0.285）。20例患者（33.3%）存在不对称畸形，性别之间无统计学显著差异（p = 0.206）。手术矫正的中位持续时间为73分钟，男性较长（p = 0.312）。27例患者植入了两根钢板，性别之间无显著差异（p = 0.454）。并发症发生率为25%（15/60），基于植入钢板数量（p = 0.178）、性别（p = 0.863）或是否存在不对称畸形（p = 0.527）无显著差异。伤口血清肿发生率为10%（6/60），是最常见的并发症。术后中位住院时间为5天，男性和女性之间（p = 0.653）以及植入不同数量钢板的患者之间（p = 0.600）无显著差异。5例患者（8.3%）需要再次住院和再次手术。1例患者因对铬过敏导致钢板取出，4例患者因伤口脓肿（1例）和血清肿（3例）接受了V.A.C.®治疗（美国KCI公司）。
微创漏斗胸修复术是治疗成年漏斗胸患者的有效手术技术。即使没有儿童漏斗胸矫正的经验，该技术也能安全地学习和实施。
成年患者 - MIRPE漏斗胸
