Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei, 11490, Taiwan.
Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
World J Surg. 2020 Jun;44(6):2035-2041. doi: 10.1007/s00268-020-05412-6.
This study aimed to investigate the relationship between bleb formation, primary spontaneous pneumothorax (PSP) and pectus excavatum (PE).
From July 2005 to December 2016, the records of 514 patients with PE who underwent the Nuss procedure were obtained from a prospectively collected database and reviewed. Clinical features, images and treatments were analyzed retrospectively.
The incidence rate of bleb formation was 26.5% in PE patients. The bleb group had a greater body height (174.4 cm vs. 170.4 cm, p < 0.001), a higher Haller index (HI; 4.2 vs. 3.43, p < 0.001) and a higher risk of developing PSP than the non-bleb group (risk ratio 9.8, p = 0.002). HI values larger than 3.615 had good discriminatory power for predicting bleb formation in patients with PE. With each increase in the HI, PE patients had a 2.2-fold greater odds ratio of bleb formation (odds ratio 2.221, CI 1.481-3.330, p < 0.001).
We discovered that a high percentage of PE patients have bleb formation and a higher risk of PSP, especially those with an HI >3.615. High-resolution computed tomography of the chest may be useful for evaluating both the HI and the presence of blebs in the lungs before performing a corrective surgical procedure.
本研究旨在探讨囊泡形成、原发性自发性气胸（PSP）和漏斗胸（PE）之间的关系。
从 2005 年 7 月至 2016 年 12 月，从一个前瞻性收集的数据库中获得了 514 例接受 Nuss 手术的 PE 患者的记录，并进行了回顾性分析。分析了临床特征、影像学表现和治疗方法。
PE 患者囊泡形成的发生率为 26.5%。囊泡组患者的身高更高（174.4cm 比 170.4cm，p<0.001），Haller 指数（HI）更高（4.2 比 3.43，p<0.001），发生 PSP 的风险也高于非囊泡组（风险比 9.8，p=0.002）。HI 值大于 3.615 对预测 PE 患者囊泡形成具有良好的区分能力。随着 HI 值的增加，PE 患者囊泡形成的比值比增加 2.2 倍（比值比 2.221，95%置信区间 1.481-3.330，p<0.001）。
我们发现相当一部分 PE 患者存在囊泡形成和较高的 PSP 风险，尤其是 HI>3.615 的患者。胸部高分辨率计算机断层扫描可能有助于在进行矫正手术前评估 HI 和肺部囊泡的存在。
