Sujka Joseph, Benedict Leo Andrew, Fraser Jason D, Aguayo Pablo, Millspaugh Daniel L, St Peter Shawn D
1 Department of Surgery, Children's Mercy Hospital , Kansas City, MO.
2 Department of Anesthesia, Children's Mercy Hospital , Kansas City, MO.
J Laparoendosc Adv Surg Tech A. 2018 Nov;28(11):1383-1386. doi: 10.1089/lap.2018.0111. Epub 2018 Jun 21.
Pain is the main factor that determines the postoperative course for patients undergoing pectus bar placement. Cryoablation of the intercostal nerves has been suggested to mitigate this pain. We instituted a protocol for using intercostal cryoablation and report our early results compared to our immediately previous cohort.
A retrospective study was conducted on patients undergoing minimally invasive repair for pectus excavatum between January 1, 2017, and August 21, 2017. Demographic data, anthropometrics, operative times, type and duration of patient analgesia, and postoperative length of stay were collected. Descriptive statistics were performed with all means reported ± standard deviations. Comparisons between groups were analyzed on STATA using T-tests with a P value <.05 determined as significant.
Twenty-eight patients were treated for pectus excavatum during the study period with 9 (32%) undergoing cryoablation. Mean number of rib spaces ablated was 5 ± 0.53 with no reported intraoperative complications. Mean operative time was 30 minutes longer in the cryoablation group (P = .00). Days to only oral pain medication was shorter in the cryoablation group, (1.22 ± 0.66 day versus 2.63 ± 0.68 day, P = .00). Length of stay, in days, was shorter in the cryoablation group (1.4 ± 0.72 days versus 4.0 ± 1.0 days, P = .00). There were no reported complications from cryoablation or bar placement during the study period. Days to discontinuation of oral narcotics were less in the cryoablation group (8.2 ± 7.0 versus 18.2 ± 10.4, P = .00).
Cryoablation after pectus bar placement dramatically decreases narcotic usage and postoperative length of stay.
疼痛是决定漏斗胸患者放置鸡胸矫治钢板术后恢复过程的主要因素。有人提出肋间神经冷冻消融术可减轻这种疼痛。我们制定了一项使用肋间冷冻消融术的方案，并报告与前一批患者相比的早期结果。
对2017年1月1日至2017年8月21日期间接受漏斗胸微创修复手术的患者进行回顾性研究。收集人口统计学数据、人体测量学数据、手术时间、患者镇痛类型和持续时间以及术后住院时间。采用描述性统计，所有均值报告为±标准差。使用STATA进行组间比较，采用T检验，P值<0.05被确定为具有统计学意义。
在研究期间，28例患者接受了漏斗胸治疗，其中9例（32%）接受了冷冻消融术。消融的平均肋间隙数为5±0.53，未报告术中并发症。冷冻消融组的平均手术时间长30分钟（P = 0.00）。冷冻消融组仅使用口服止痛药的天数更短（1.22±0.66天对2.63±0.68天，P = 0.00）。冷冻消融组的住院天数更短（1.4±0.72天对4.0±1.0天，P = 0.00）。在研究期间，未报告冷冻消融术或放置鸡胸矫治钢板的并发症。冷冻消融组停用口服麻醉剂的天数更少（8.2±7.0对18.2±10.4，P = 0.00）。
鸡胸矫治钢板放置后进行冷冻消融术可显著减少麻醉剂使用量和术后住院时间。
