Sollie Zachary W, Gleason Frank, Donahue James M, Wei Benjamin
Division of Cardiothoracic Surgery, UAB Department of Surgery, Birmingham, Ala.
JTCVS Tech. 2022 Jan 19;12:212-219. doi: 10.1016/j.xjtc.2021.12.008. eCollection 2022 Apr.
Open correction of pectus deformities has evolved since its origin. We performed a Ravitch type repair using a permanent titanium plate fixed with screws and describe the procedure with outcomes after our modifications.
A retrospective review of 61 pectus excavatum and pectus carinatum cases from August 2013 to April 2021 was performed. Data were extracted from medical records and reported. In January 2016, we began administering satisfaction surveys at the 6-month postoperative visit; results are reported.
The mean age of our cohort was 24.5 years; 43 (70%) were male. Fifty-four underwent pectus excavatum repair, 6 pectus carinatum repair, and 1 mixed repair. Median Haller index was 3.8. Mean operative duration was 98 minutes; mean blood loss was 116.4 mL. Median chest tube duration was 5.0 days; median hospital stay was 4 days. Reexploration for bleeding was 30% in the first 10 patients. Protocol changes including postponing chemical deep vein thrombosis prophylaxis, using intraoperative hemostatic agents, and using shorter implantation screws decreased this to 0% for the remaining cases. The most frequent complication was urinary retention (21.3%). Postoperative surveys were completed for 37 of 50 patients. Seventy-five percent reported health improved, 65% reported exercise capacity improved, 75% reported breathing improved, and 59% reported chest pain improved. Self-esteem improved from 6.6 ± 2.5 (of 10) before surgery to 8.2 ± 2.1 after surgery. Ninety percent were satisfied and 86% would have the operation again.
Ravitch type repair with permanent titanium plate fixation is a safe and effective procedure for correction of pectus excavatum and carinatum. Most patients experience improvement in preoperative symptoms.
自其起源以来，漏斗胸畸形的开放矫正术不断发展。我们采用了用螺钉固定的永久性钛板进行Ravitch式修复，并描述了经过我们改良后的手术步骤及结果。
对2013年8月至2021年4月期间的61例漏斗胸和鸡胸病例进行回顾性研究。从病历中提取数据并进行报告。2016年1月，我们开始在术后6个月的随访中进行满意度调查；报告了结果。
我们队列的平均年龄为24.5岁；43例（70%）为男性。54例接受漏斗胸修复，6例接受鸡胸修复，1例接受混合修复。Haller指数中位数为3.8。平均手术时间为98分钟；平均失血量为116.4毫升。胸管留置时间中位数为5.0天；住院时间中位数为4天。前10例患者中因出血进行再次手术的比例为30%。方案改变包括推迟化学性深静脉血栓预防、使用术中止血剂以及使用更短的植入螺钉，这使得其余病例中该比例降至0%。最常见的并发症是尿潴留（21.3%）。50例患者中有37例完成了术后调查。75%的患者报告健康状况改善，65%的患者报告运动能力改善，75%的患者报告呼吸改善，59%的患者报告胸痛改善。自尊评分从术前的6.6±2.5（满分10分）提高到术后的8.2±2.1。90%的患者表示满意，86%的患者愿意再次接受手术。
采用永久性钛板固定的Ravitch式修复术是矫正漏斗胸和鸡胸的一种安全有效的手术方法。大多数患者术前症状有所改善。
