Kocher Gregor J, Gstrein Nathalie, Jaroszewski Dawn E, Ewais Mennatallah M, Schmid Ralph A
Division of General Thoracic Surgery, University Hospital Bern/Inselspital, Bern, Switzerland ;
Division of Cardiothoracic Surgery, Mayo Clinic, Arizona, USA.
J Thorac Dis. 2016 Aug;8(8):1981-5. doi: 10.21037/jtd.2016.06.60.
Recurrence of pectus excavatum (PE) is not an uncommon problem after open repair using the Ravitch technique. The optimal approach for redo surgery is still under debate, especially in adults with less chest wall pliability. Aim of this study was to investigate the usefulness and efficacy of the minimally invasive Nuss technique for repair of recurrent PE after conventional open repair.
We performed a retrospective multicentre review of 20 adult patients from University Hospital Bern (n=6) and the US Mayo Clinic (n=14) who underwent minimally invasive repair of recurrent PE after unsuccessful prior Ravitch procedure.
Mean patient age at primary open correction was 21 years, with recurrence being evident after a mean duration of 10.5 years (range, 0.25-47 years). Mean age at redo surgery using the Nuss technique was 31 years, with a mean Haller index of 4.7 before and 2.5 after final correction. Main reason for redo surgery was recurrent or persistent deformity (100%), followed by chest pain (75%) and exercise intolerance (75%). No major intraoperative or postoperative complications occurred and successful correction was possible in all patients.
Although the procedure itself is more challenging, the minimally invasive Nuss technique can be safely and successfully used for repair of recurrent PE after failed open surgery. In our series final results were good to excellent in the majority of patients without major complications or recurrence.
采用Ravitch技术进行开放性修复后，漏斗胸（PE）复发并非罕见问题。再次手术的最佳方法仍存在争议，尤其是对于胸壁柔韧性较差的成年人。本研究的目的是探讨微创Nuss技术在传统开放性修复后复发性PE修复中的实用性和有效性。
我们对来自伯尔尼大学医院（n = 6）和美国梅奥诊所（n = 14）的20例成年患者进行了回顾性多中心研究，这些患者在先前的Ravitch手术失败后接受了复发性PE的微创修复。
初次开放性矫正时患者的平均年龄为21岁，平均10.5年后（范围0.25 - 47年）复发明显。采用Nuss技术进行再次手术时的平均年龄为31岁，最终矫正前平均Haller指数为4.7，矫正后为2.5。再次手术的主要原因是复发或持续畸形（100%），其次是胸痛（75%）和运动不耐受（75%）。未发生重大术中或术后并发症，所有患者均成功矫正。
尽管该手术本身更具挑战性，但微创Nuss技术可安全、成功地用于开放性手术失败后复发性PE的修复。在我们的系列研究中，大多数患者的最终结果良好至优秀，无重大并发症或复发。
