Sigl Stephan, Del Frari Barbara, Harasser Carina, Schwabegger Anton H
Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University Innsbruck, Innsbruck, Austria.
Interact Cardiovasc Thorac Surg. 2018 Mar 1;26(3):474-479. doi: 10.1093/icvts/ivx353.
Creating an aesthetically appealing result using thoracoplasty, especially when correcting extensive deformities, but only causing low morbidity, is challenging. The frequency of thoracoplasties in cases of pectus carinatum (PC) has increased due to improved experience and modified surgical techniques, resulting in low morbidity and low complication rates. The indications for surgical treatment are still controversial and, in most cases, remain aesthetic or psychological rather than physiological. However, whether cardiopulmonary function changes after surgical repair remains a matter of controversy. We sought to investigate and shed light on published knowledge regarding this question.
We searched MEDLINE and PubMed databases, using various defined search phrases and inclusion criteria, to identify articles on pre- and postoperative cardiopulmonary evaluation and outcomes.
Six studies met the inclusion criteria: 5 studies evaluated patients with PC for cardiopulmonary outcomes after chest wall surgery and 1 did so following conservative compression treatment. In these studies, surgical and conservative correction of PC did not reduce absolute lung volumes and spirometric measurements and consequently had no pathogenic effect on cardiopulmonary function.
The results of this systematic review suggest that surgical correction of PC has no symptomatic pathogenic effect on cardiopulmonary function. The results, however, revealed both heterogeneity in the examinations used and inconsistent methods within each study. Further prospective trials with a stronger methodological design are necessary to objectively confirm that surgical correction of PC does not impair cardiopulmonary function.
使用胸廓成形术获得美观的效果具有挑战性,尤其是在矫正广泛畸形时,同时要尽量降低发病率。由于经验的增加和手术技术的改进,鸡胸(PC)病例中胸廓成形术的频率有所上升,从而降低了发病率和并发症发生率。手术治疗的适应症仍存在争议,在大多数情况下,仍主要是出于美观或心理因素而非生理因素。然而,手术修复后心肺功能是否改变仍是一个有争议的问题。我们试图对已发表的关于这个问题的知识进行调查并加以阐明。
我们使用各种定义的搜索词和纳入标准,在MEDLINE和PubMed数据库中进行搜索,以识别有关术前和术后心肺评估及结果的文章。
六项研究符合纳入标准:5项研究评估了鸡胸患者胸壁手术后的心肺结局,1项研究评估了保守压迫治疗后的心肺结局。在这些研究中,鸡胸的手术和保守矫正并未降低绝对肺容量和肺功能测量值,因此对心肺功能没有致病作用。
本系统评价的结果表明,鸡胸的手术矫正对心肺功能没有症状性致病作用。然而,结果显示所用检查存在异质性,且每项研究中的方法也不一致。需要进一步进行方法设计更严谨的前瞻性试验,以客观证实鸡胸的手术矫正不会损害心肺功能。