鸡胸矫正器取出术：避免并发症的手术技术与策略
Pectus bar removal: surgical technique and strategy to avoid complications.
作者信息
Park Hyung Joo, Kim Kyung Soo
机构信息
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea.
出版信息
J Vis Surg. 2016 Mar 23;2:60. doi: 10.21037/jovs.2016.02.27. eCollection 2016.
BACKGROUND
Pectus bar removal is the final stage of the procedure for minimally invasive repair of pectus excavatum. Based on our experience with one of the largest scale data, we would like to address the important issues in pectus bar removal, such as appropriate duration of bar maintenance, techniques for bar removal, and strategies to avoid complications.
METHODS
Between September 1999 and August 2015, we operated on 2,553 patients with pectus excavatum and carinatum using pectus bars for a minimally invasive approach. Among them, 1,821 patients (71.3%) underwent pectus bar removal as a final stage of pectus deformity repair, and their data were analyzed retrospectively to identify the outcomes and adverse effects of the pectus bar removal procedure. The mean age of the patients was 9.13 years (range, 16 months to 44 years) and the male to female ratio was 3.55. The study is approved by the Institutional Review Board (IRB), the ethical committee of Seoul St. Mary's Hospital. The IRB has exempted the informed consent from every patient in this study due to this is a retrospective chart review without revealing any patients' personal data.
RESULTS
Our technique involved straightening of the bar in a supine position. The overall mean duration of pectus bar maintenance was 2.57 years (range, 4 months to 14 years). The mean duration was 2.02 years (range, 4 months to 7 years) for children under 12 years, 2.99 years (range, 7 months to 9 years) for teenagers aged 12-20 years, and 3.53 years (range, 3 months to 14 years) for adults over 20 years. Forty-eight patients (2.6%) underwent bar removal more than 5 years after bar insertion and 58 patients (3.2%) underwent bar removal earlier than initially planned. The most common adverse reaction after bar removal was wound seroma including infection (43 patients, 2.36%). Recurrence after bar removal occurred in nine patients (0.49%), and seven of these required redo repair (0.38%).
CONCLUSIONS
Pectus bar removal is a safe and straightforward procedure with a low rate of complication.
背景
鸡胸矫治器取出是漏斗胸微创修复手术的最后阶段。基于我们在最大规模数据之一上的经验，我们想探讨鸡胸矫治器取出中的重要问题，如矫治器的合适保留时间、取出技术以及避免并发症的策略。
方法
1999年9月至2015年8月期间，我们对2553例漏斗胸和鸡胸患者采用鸡胸矫治器进行微创治疗。其中，1821例患者（71.3%）接受了鸡胸矫治器取出术作为胸廓畸形修复的最后阶段，对他们的数据进行回顾性分析以确定鸡胸矫治器取出术的结果和不良反应。患者的平均年龄为9.13岁（范围为16个月至44岁），男女比例为3.55。本研究经机构审查委员会（IRB），即首尔圣母医院伦理委员会批准。由于本研究是一项回顾性病历审查且未披露任何患者的个人数据，IRB免除了每位患者的知情同意。
结果
我们的技术包括在仰卧位将矫治器拉直。鸡胸矫治器的总体平均保留时间为2.57年（范围为4个月至14年）。12岁以下儿童的平均保留时间为2.02年（范围为4个月至7年），12 - 20岁青少年为2.99年（范围为7个月至9年），20岁以上成人为3.53年（范围为3个月至14年）。48例患者（2.6%）在矫治器植入5年以上后取出，58例患者（3.2%）比最初计划更早取出。取出矫治器后最常见的不良反应是包括感染的伤口血清肿（43例患者，2.36%）。取出矫治器后复发的有9例患者（0.49%），其中7例需要再次修复（0.38%）。
结论
鸡胸矫治器取出是一种安全、直接且并发症发生率低的手术。
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