Dore Mariela, Triana Junco Paloma, De La Torre Carlos, Vilanova-Sánchez Alejandra, Bret Monserrat, Gonzalez Gaspar, Nuñez Cerezo Vanesa, Jimenez Gomez Javier, Luis Encinas Jose, Hernandez Francisco, Martínez Martínez Leopoldo, Lopez Santamaria Manuel
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain.
Department of Pediatric Radiology, Hospital Universitario La Paz, Madrid, Madrid, Spain.
European J Pediatr Surg Rep. 2018 Jan;6(1):e18-e22. doi: 10.1055/s-0038-1623537. Epub 2018 Feb 20.
Minimally invasive repair for pectus excavatum (MIRPE) is controversial in extremely severe cases of pectus excavatum (PE) and an open repair is usually favored. Our aim is to describe a case of a patient with an extremely severe PE that underwent a minimally invasive approach. An 8-year-old girl with severe sternum depression was assessed. She had a history of exercise intolerance, nocturnal dyspnea, fatigue, and shortness of breath. Chest computed tomography showed that sternum depression was posterior to the anterior vertebral column; therefore, Haller and correction index could not be measured. Spirometry indicated an obstructive ventilation pattern (forced expiratory volume in 1 second = 74.4%), and echocardiogram revealed a dilated inferior vena cava, mitral valve prolapse with normal ventricular function. After multidisciplinary committee evaluation, a MIRPE approach was performed. All symptoms had disappeared at the 3-month postoperative follow-up; the desired sternum shape was achieved and normalization of cardiopulmonary function was observed. The Nuss bars were removed after a 2-year period. After 18-month follow-up, the patient can carry out normal exercise and is content with the cosmetic result. Nuss procedure is feasible in our 8-year-old patient. In this case, both the Haller and correction index were not useful to assess the severity of PE. Therefore, under these circumstances, other radiologic parameters have to be taken into consideration for patient evaluation.
漏斗胸微创修复术（MIRPE）在漏斗胸（PE）极重度病例中存在争议，通常更倾向于开放性修复。我们的目的是描述一例采用微创方法治疗的极重度PE患者的病例。
一名8岁患有严重胸骨凹陷的女孩接受了评估。她有运动不耐受、夜间呼吸困难、疲劳和呼吸急促的病史。胸部计算机断层扫描显示胸骨凹陷位于椎体前方之后；因此，无法测量哈勒指数和矫正指数。肺功能测定显示为阻塞性通气模式（一秒用力呼气量 = 74.4%），超声心动图显示下腔静脉扩张，二尖瓣脱垂，心室功能正常。经过多学科委员会评估后，实施了MIRPE手术。术后3个月随访时所有症状均消失；实现了理想的胸骨形状，观察到心肺功能恢复正常。两年后取出了努斯棒。随访18个月后，患者能够进行正常运动，对美容效果满意。
努斯手术在我们这位8岁患者中是可行的。在该病例中，哈勒指数和矫正指数对评估PE的严重程度均无用。因此，在这种情况下，进行患者评估时必须考虑其他影像学参数。
