Children's Hospital of The King's Daughters, Norfolk, VA.
Eastern Virginia Medical School, Norfolk, VA.
Ann Surg. 2022 Feb 1;275(2):e496-e502. doi: 10.1097/SLA.0000000000003877.
To review standardized Nuss correction of pectus excavatum and vacuum bell treatment over the last 10 years.
In 2010, we reported 21 years of the Nuss procedure in 1215 patients.
Over the last 10 years, 2008-2018, we evaluated 1885 pectus excavatum patients. Surgery was indicated for well-defined objective criteria. A consistent operation was performed by 8 surgeons in 1034 patients, median 15 years, (range 6-46); 996 were primary, and 38 redo operations. Surgical patients' mean computed tomography index was 5.46. Mitral valve prolapse was present in 5.4%, Marfan syndrome in 1.1% and scoliosis in 29%. Vacuum bell treatment was introduced for 218 patients who did not meet surgical criteria or were averse to surgery.
At primary operation, 1 bar was placed in 49.8%; 2 bars, 49.4%; and 3 bars, 0.7%. There were no deaths. Cardiac perforation occurred in 1 patient who had undergone previous cardiac surgery. Paraplegia after epidural catheter occurred once. Reoperation for bar displacement occurred in 1.8%, hemothorax in 0.3%, and wound infection in 2.9%; 1.4% required surgical drainage. Allergy to stainless steel was identified in 13.7%. A good anatomic outcome was always achieved at bar removal. Recurrence requiring reoperation occurred in 3 primary surgical patients. Two patients developed carinate overcorrection requiring reoperation. Vacuum bell treatment produced better results in younger and less severe cases.
A standardized Nuss procedure was performed by multiple surgeons in 1034 patients with good overall safety and results in primary repairs. Vacuum bell treatment is useful.
回顾过去 10 年中标准化 Nuss 矫正漏斗胸和真空钟治疗的情况。
2010 年，我们报告了 1215 例患者的 Nuss 手术 21 年经验。
在过去的 10 年中，即 2008 年至 2018 年，我们评估了 1885 例漏斗胸患者。手术指征为明确的客观标准。8 位外科医生对 1034 例患者进行了一致的手术，中位数为 15 年（范围为 6-46 年）；996 例为原发性手术，38 例为再次手术。手术患者的平均计算机断层扫描指数为 5.46。二尖瓣脱垂发生率为 5.4%，马凡综合征发生率为 1.1%，脊柱侧凸发生率为 29%。对不符合手术标准或不愿手术的 218 例患者引入了真空钟治疗。
在初次手术中，放置 1 个钟的占 49.8%；放置 2 个钟的占 49.4%；放置 3 个钟的占 0.7%。无死亡病例。1 例曾接受过心脏手术的患者发生心脏穿孔。1 例硬膜外导管发生截瘫。1.8%的患者需要再次手术以矫正钟的移位，0.3%的患者发生血胸，2.9%的患者发生伤口感染；1.4%的患者需要手术引流。13.7%的患者对不锈钢过敏。在拆除钟时，始终获得良好的解剖学结果。3 例初次手术患者出现需要再次手术的复发。2 例患者发生胸骨过度矫正，需要再次手术。真空钟治疗对年轻和病情较轻的患者效果更好。
多名外科医生对 1034 例患者进行了标准化的 Nuss 手术，初次修复的总体安全性和效果良好。真空钟治疗是有用的。
