Schwabegger Anton H, Del Frari Barbara, Metzler Julia
Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University Innsbruck, 6020, Innsbruck, Austria.
Wien Klin Wochenschr. 2017 Oct;129(19-20):702-708. doi: 10.1007/s00508-017-1214-y. Epub 2017 May 24.
For the correction of pectus excavatum (PE) deformities in adolescents, adults, and generally in asymmetric cases, a semi-open approach called the MOVARPE (minor open videoendoscopically assisted repair of pectus excavatum) technique is used, consisting of standard pectus bar implantation hybridized with auxiliary sternum osteotomy and multiple chondrotomies. In this study, we report our experiences, discuss pros and cons, and provide technical refinements.
Between September 2005 and March 2015, 61 patients were selected to undergo the MOVARPE instead of the standard MIRPE (minimally invasive repair of pectus excavatum) procedure because of age or specific morphologic characteristics of PE. Patient age ranged from 14 to 45 years (mean 23.4 years).
Auxiliary incisions for skeletal relaxation enabled symmetric remodeling and, in most cases, circumvented the need for a second pectus bar. The bars were left in position for a mean of 19.3 months (range: 12 to 35 months). There were no major complications. Minor complications such as pleural effusion, temporary pneumothorax, and mild recurrence of the deformity after bar removal were seen at rates similar to those for standard techniques. In the current study reporting outcomes of the previously described MOVARPE procedure, the authors saw no evidence of a possible disadvantage in the overall concept or execution of the procedure for the suggested indication.
From this experience, we can state that, as an alternative to the MIRPE technique, MOVARPE is a method that offers high efficacy, particularly for rigid and complex pectus excavatum deformities at or beyond puberty.
对于青少年、成年人以及一般不对称病例的漏斗胸（PE）畸形矫正，采用一种称为MOVARPE（漏斗胸微创视频内镜辅助修复术）的半开放方法，该技术包括标准的漏斗胸钢板植入，并结合辅助胸骨截骨术和多处软骨切开术。在本研究中，我们报告了我们的经验，讨论了优缺点，并提供了技术改进。
2005年9月至2015年3月期间，由于年龄或PE的特定形态特征，选择61例患者接受MOVARPE而非标准的MIRPE（漏斗胸微创修复术）手术。患者年龄范围为14至45岁（平均23.4岁）。
用于骨骼松弛的辅助切口能够实现对称重塑，并且在大多数情况下，避免了使用第二根漏斗胸钢板的需要。钢板平均留置19.3个月（范围：12至35个月）。没有重大并发症。出现少量并发症，如胸腔积液、暂时性气胸和钢板取出后畸形轻度复发，其发生率与标准技术相似。在本研究报告先前描述的MOVARPE手术结果时，作者未发现该手术的整体概念或实施对于所建议适应症存在可能的劣势的证据。
根据这一经验，我们可以指出，作为MIRPE技术的替代方法，MOVARPE是一种疗效高的方法，尤其适用于青春期及青春期后僵硬和复杂的漏斗胸畸形。
