The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Pediatrics, St. Louis Children's Hospital, St. Louis, Missouri.
Ann Thorac Surg. 2020 Jul;110(1):272-275. doi: 10.1016/j.athoracsur.2019.12.012. Epub 2020 Jan 23.
Limited data exist for pectus excavatum repair in adults. We reviewed outcomes in adult patients undergoing Ravitch or Nuss pectus excavatum repairs to determine whether there was a statistical difference in postoperative complications and recurrence between primary and redo operations.
Patients undergoing pectus excavatum repair between 2001 and 2018 were excluded if they were receiving a concurrent unrelated operation, aged younger than 18 years, or had less than 1 year of follow-up (for recurrence analysis). Postoperative complications were recorded based on procedure type (Ravitch/Nuss) and iteration of repair (primary/redo). Continuous patient data were compared using Student t tests for variables such as age, length of stay, estimated blood loss, body mass index, and number of bars inserted. Fisher exact or χ tests were performed for postoperative complications and recurrence rates between groups.
Of 290 patients, there were no significant differences in postoperative complications or recurrence rates between all Nuss repairs (n = 237; P = .59) and all Ravitch repairs (n = 53; P = .48), redo Nuss repairs (n = 53; P = .26) and Ravitch repairs (n=26; P = .99), and primary (P = .26) and redo Nuss (P = .10) repairs or primary (P = .99) and redo Ravitch (P = .99) repairs. There were significant differences in age, length of stay, follow-up, bars inserted, and estimated blood loss between all Nuss and Ravitch repairs (P < .05).
Postoperative complication and recurrence rates were not statistically different between Nuss and Ravitch procedures of all types, suggesting either procedure may have utility in recurrent pectus excavatum. Further research may look to expand sample size and a prospective study investigating long-term outcomes.
成人漏斗胸修复的相关数据有限。我们回顾了接受 Ravitch 或 Nuss 漏斗胸修复术的成年患者的结果，以确定原发性和再次修复手术之间术后并发症和复发是否存在统计学差异。
如果患者同时进行其他无关手术、年龄小于 18 岁或随访时间少于 1 年（用于复发分析），则排除在接受漏斗胸修复的患者之外。根据手术类型（Ravitch/Nuss）和修复次数（原发性/再次）记录术后并发症。对于年龄、住院时间、估计失血量、体重指数和插入的肋骨数量等连续患者数据，使用 Student t 检验进行比较。对于各组之间的术后并发症和复发率，采用 Fisher 确切检验或 χ 检验。
在 290 例患者中，所有 Nuss 修复术（n=237；P=0.59）和所有 Ravitch 修复术（n=53；P=0.48）、再次 Nuss 修复术（n=53；P=0.26）和 Ravitch 修复术（n=26；P=0.99）、原发性（P=0.26）和再次 Nuss 修复术（P=0.10）或原发性（P=0.99）和再次 Ravitch 修复术（P=0.99）之间，术后并发症和复发率无统计学差异。所有 Nuss 和 Ravitch 修复术之间在年龄、住院时间、随访时间、插入肋骨数量和估计失血量方面存在显著差异（P<0.05）。
Nuss 和 Ravitch 手术的所有类型之间，术后并发症和复发率没有统计学差异，这表明两种手术方法在复发性漏斗胸中均具有一定的应用价值。进一步的研究可能需要扩大样本量，并进行一项前瞻性研究以调查长期结果。
