Togoro Silvia Yukari, Tedde Miguel Lia, Eisinger Robert S, Okumura Erica Mie, de Campos Jose Ribas Milanez, Pêgo-Fernandes Paulo Manuel
Thoracic Surgery Department, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
Thoracic Surgery Department, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
J Pediatr Surg. 2018 Mar;53(3):406-410. doi: 10.1016/j.jpedsurg.2017.04.016. Epub 2017 May 1.
To minimize cardiac perforation during the minimally invasive repair of pectus excavatum (MIRPE), several surgeons have suggested using a suction device to intraoperatively lift the sternum. Whether or not this technique is effective for all PE patients is not yet known. As such, our aim was to quantify the extent to which a suction device is capable of lifting the sternum with a short duration of use.
30 PE patients received a low-dose CT scan as part of standard PE evaluation. A Vacuum Bell suction was then applied for only two minutes, and a repeat CT scan was obtained only at the deepest point of the chest wall deformity. We compared chest dimensions before and after Vacuum Bell suction.
The Vacuum Bell lifted the sternum in all 29 patients included in the analysis. The absolute change in depth ranged from 0.29 to 23.67mm (M=11.02, SD=6.05). The average improvement in Haller index was 0.76. The suction was most effective for individuals with low BMI and smaller chest depths. Efficacy was not associated with gender, age, or chest morphology.
The Vacuum Bell device effectively lifted the sternum in PE patients with different demographics and chest morphologies. Future research is needed to address whether or not the device reduces risk of cardiac perforation during MIRPE.
Prognosis Study Level IV.
为了在微创漏斗胸修复术（MIRPE）期间将心脏穿孔的风险降至最低，一些外科医生建议在术中使用吸引装置来抬起胸骨。该技术是否对所有漏斗胸患者均有效尚不清楚。因此，我们的目的是量化吸引装置在短时间使用内能够抬起胸骨的程度。
30例漏斗胸患者接受了低剂量CT扫描作为标准漏斗胸评估的一部分。然后仅应用真空钟吸引两分钟，并且仅在胸壁畸形的最深点获得重复CT扫描。我们比较了真空钟吸引前后的胸部尺寸。
在纳入分析的所有29例患者中，真空钟均抬起了胸骨。深度的绝对变化范围为0.29至23.67mm（M = 11.02，SD = 6.05）。哈勒指数的平均改善为0.76。吸引对BMI低和胸深较小的个体最有效。疗效与性别、年龄或胸部形态无关。
真空钟装置有效地抬起了不同人口统计学特征和胸部形态的漏斗胸患者的胸骨。需要进一步研究该装置是否能降低MIRPE期间心脏穿孔的风险。
预后研究IV级。
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