Bilgi Zeynep, Ermerak Nezih Onur, Çetinkaya Çagatay, Laçin Tunç, Yüksel Mustafa
Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey.
Interact Cardiovasc Thorac Surg. 2017 Feb 1;24(2):257-259. doi: 10.1093/icvts/ivw322.
The aim of this study is to present our experience with Nuss bar removal and evaluate potential risk factors. The Nuss procedure requires an operation to remove the bar 2-3 years after the initial correction. Although removal of the bar is generally believed to be safe, perioperative complications including major bleeding can occur.
All cases involving removal of the Nuss bar done since April 2007 were recorded in a prospective database. Data were collected on the amount of blood loss, the number of diagnostic interventions, operative management and postoperative course.
Of a total of 246 (162 with single bars, 80 with double bars, 4 with triple bars) cases, 43 patients (17.5%) experienced perioperative complications. Five patients underwent secondary postoperative interventions; one patient required same-session emergency video-assisted thoracic surgery (VATS) due to major bleeding. Patients who had complications were significantly older than patients with no complications (20.5 ± 6.5 years vs 17.2 ± 5.9 years, P = 0.002). People having double bars removed were significantly more likely to have perioperative complications (12% vs 27%, P = 0.03) and complications requiring secondary interventions (n = 1 for a single bar, n = 5 for double bars, P = 0.01).
Major complications after removal of the Nuss bar occur with some frequency. Although the double-bar removals in our cohort were associated with major complications, the reasons are poorly understood. Immediate management of the complications may require multidisciplinary care. Multicentric pooling of cases is needed for better risk stratification.
本研究旨在介绍我们在取出努氏棒方面的经验，并评估潜在风险因素。努氏手术需要在初次矫正后2至3年进行取出棒的手术。尽管一般认为取出棒是安全的，但围手术期仍可能发生包括大出血在内的并发症。
自2007年4月以来所有涉及取出努氏棒的病例均记录在一个前瞻性数据库中。收集了失血量、诊断性干预次数、手术管理及术后病程等数据。
在总共246例（单棒162例，双棒80例，三棒4例）病例中，43例患者（17.5%）发生围手术期并发症。5例患者术后接受了二次干预；1例患者因大出血在同一次手术中需要急诊电视辅助胸腔镜手术（VATS）。发生并发症的患者明显比未发生并发症的患者年龄大（20.5±6.5岁对17.2±5.9岁，P = 0.002）。取出双棒的患者发生围手术期并发症的可能性明显更高（12%对27%，P = 0.03），且发生需要二次干预的并发症的可能性也更高（单棒1例，双棒5例，P = 0.01）。
取出努氏棒后主要并发症时有发生。尽管我们队列中的双棒取出与主要并发症相关，但其原因尚不清楚。并发症的即时处理可能需要多学科护理。需要多中心病例汇总以进行更好的风险分层。
