Xu Bing, Xu Ting, Wang Shan, Li Wenhua, He Taozhen, Liu Wenying
Department of Pediatric Surgery in the Center of Children Medicine.
Department of Anesthesiology.
Medicine (Baltimore). 2019 Feb;98(6):e14387. doi: 10.1097/MD.0000000000014387.
This study was aimed to review the current experience regarding the correction of pectus excavatum by Nuss procedure with nonthoracoscopic assistance using trans-esophageal echocardiography monitoring.A total of 172 patients with pectus excavatum were surgically treated from August 2011 to August 2016. The sample size comprised 131 boys and 41 girls and the average age was 13 years and 2 months. A total of 144 cases were initially operated on, whereas 13 subjects exhibited postoperative recurrence following Ravitch repair of a pectus excavatum deformity and 15 cases experienced a history of median sternotomy. The intraoperative Haller index ranged from 3.6 to 14.2 (mean 4.1). The intraoperative TEE monitoring was conducted with middle-esophageal 4-champer view and middle-esophageal Aortic short axis view to detect the injury of heart and of the large vessels by the introducer and Nuss steel bars.The operation conducted in all patients was successful in the absence of severe complications. The time of operation ranged from 38 to 80 minutes (mean 50 minutes). The bleeding volume during the procedure was between 10 and 40 mL (mean 15 mL). The time from operation to discharge was from 5 to 7 days (mean 6 days). Pneumothorax occurred in 25 cases following the termination of the operation, including 9 cases of needle puncture aspiration and 6 cases of closed drainage. Pleural effusion occurred in 4 cases. No patients suffered from wood infection. Effusion occurred in 9 cases following 6 to 23 months, whereas dressing changes and surgical debridement were evident in 2 and 7 cases, respectively. The bars were removed in 82 of the 172 patients within 3 years. The progression of the thoracic wall was assessed for the period of 8 to 68 months following the surgery, during the follow-up period. The average time period of follow-up was 32 months.Nuss procedure with nonthoracoscopic assistance with trans-esophageal echocardiography monitoring for the correction of pectus excavatum was safe for all of the cases investigated. It exhibited lesser trauma and required a shorter time period.
本研究旨在回顾经食管超声心动图监测下非胸腔镜辅助Nuss手术矫治漏斗胸的当前经验。2011年8月至2016年8月期间，共有172例漏斗胸患者接受了手术治疗。样本包括131名男孩和41名女孩，平均年龄为13岁2个月。共有144例患者首次接受手术，其中13例在Ravitch修复漏斗胸畸形后出现术后复发，15例有正中胸骨切开术史。术中Haller指数范围为3.6至14.2（平均4.1）。术中采用食管中段四腔心切面和食管中段主动脉短轴切面进行经食管超声心动图监测，以检测导引器和Nuss钢棒对心脏和大血管的损伤。所有患者的手术均成功，无严重并发症。手术时间为38至80分钟（平均50分钟）。术中出血量为10至40毫升（平均15毫升）。术后住院时间为5至7天（平均6天）。术后有25例发生气胸，其中9例行穿刺抽吸，6例行闭式引流。有4例发生胸腔积液。无患者发生伤口感染。术后6至23个月有9例发生积液，分别有2例和7例需要换药和手术清创。172例患者中有82例在3年内取出了钢棒。术后随访8至68个月，评估胸壁进展情况。平均随访时间为32个月。经食管超声心动图监测下非胸腔镜辅助Nuss手术矫治漏斗胸对所有研究病例均安全，创伤较小，所需时间较短。
