Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
PLoS One. 2022 Nov 11;17(11):e0277494. doi: 10.1371/journal.pone.0277494. eCollection 2022.
Nuss surgery is effective in correcting pectus excavatum (PE), with a recurrence rate of 1.2-27%. Re-do surgery is successful but still has a 6% failure rate. Patients with obstructive sleep apnea (OSA) experience repetitive PE-associated sternal depression during sleep. As the prevalence of OSA among PE patients is higher than the average, co-existing OSA in PE patients might negatively affect the efficacy of Nuss surgery. This study aimed to evaluate the impact of co-existing OSA on Nuss surgery in patients with PE. In total, 20 adult patients with PE only and 9 patients with PE and OSA were analyzed. Polysomnography was performed before Nuss surgery to evaluate OSA. Sternovertebral distance (SVD) and radiographic Haller index (RHI) were recorded before surgery and at 3, 6, and 24 months postoperatively. The results showed that percentage changes in SVD in patients with PE only at 3, 6, and 24 months postoperatively were significantly increased compared with those in the patients with PE and OSA (31.1% vs. 14.1% at 3 months; 37.5% vs. 21.4% at 6 months; 42.5% vs. 19.2% at 24 months). Meanwhile, percentage changes in RHI were significantly lower in patients with PE alone than in the patients with PE and OSA (-22.9% vs. -9.3% at 3 months; -27.9% vs. -18.7% at 6 months; -30.6% vs. -16.7% at 24 months). This study showed that co-existing OSA might reduce the efficacy of Nuss surgery for patients with PE. We recommend that patients with PE should be evaluated and treated for OSA before surgery to prevent surgical failure after bar removal.
Nuss 手术在矫正漏斗胸 (PE) 方面非常有效，复发率为 1.2-27%。再次手术是成功的，但仍有 6%的失败率。患有阻塞性睡眠呼吸暂停 (OSA) 的患者在睡眠中会经历与 PE 相关的胸骨凹陷反复发作。由于 OSA 在 PE 患者中的患病率高于平均水平，PE 患者并存 OSA 可能会对 Nuss 手术的疗效产生负面影响。本研究旨在评估合并 OSA 对 PE 患者 Nuss 手术的影响。共有 20 名仅患有 PE 的成年患者和 9 名同时患有 PE 和 OSA 的患者进行了分析。在 Nuss 手术前进行多导睡眠图检查以评估 OSA。记录术前和术后 3、6 和 24 个月的胸骨后距 (SVD) 和放射学 Haller 指数 (RHI)。结果显示，仅患有 PE 的患者在术后 3、6 和 24 个月的 SVD 百分比变化明显高于同时患有 PE 和 OSA 的患者（术后 3 个月时为 31.1%比 14.1%；术后 6 个月时为 37.5%比 21.4%；术后 24 个月时为 42.5%比 19.2%）。同时，单独患有 PE 的患者的 RHI 百分比变化明显低于同时患有 PE 和 OSA 的患者（术后 3 个月时为-22.9%比-9.3%；术后 6 个月时为-27.9%比-18.7%；术后 24 个月时为-30.6%比-16.7%）。本研究表明，合并 OSA 可能会降低 Nuss 手术治疗 PE 患者的疗效。我们建议在手术前对患有 PE 的患者进行评估和治疗 OSA，以防止在去除棒后手术失败。
