Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA.
Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA.
J Pediatr Surg. 2023 Aug;58(8):1430-1434. doi: 10.1016/j.jpedsurg.2022.12.031. Epub 2023 Jan 4.
Minimally invasive repair of pectus excavatum (MIRPE) and cartilaginous rib excision (CRE) for slipping rib syndrome (SRS) are painful procedures. Intercostal nerve cryoablation (Cryo) controls pain and decreases opioid use in MIRPE. Herein, we describe our experience with cryoablation in CRE.
A retrospective chart review was performed of all patients undergoing CRE between 2018 and 2022. Data on demographics, clinical characteristics, operative details, and hospital course were collected.
A total of 98 patients underwent CRE: 68 CRE without cryo, 22 CRE + Cryo, and 8 combined MIRPE + CRE + Cryo. Ninety percent of patients underwent bioabsorbable rib plating. Patients were predominantly female (79%, 73%, 50% respectively) with median ages 17.6, 16.9, and 14.2 years respectively. CRE + Cryo patients used significantly less opioids in hospital (0.6 OME/kg [0.1,1.2]) compared to CRE without cryo (1.0 OME/kg [0.6,2.1]), p < 0.05. The median length of stay (LOS) in CRE + Cryo was 1 day [1,2] compared to 2 days in CRE without cryo [1,2], p = 0.09. MIRPE + CRE + Cryo patients used 0.6 OME/kg [0.2,8.0] with a 2 day [1,5.5] LOS. Ninety-one percent of Cryo patients had cryoablation of T9 and/or T10 intercostal nerves, with no documented abdominal wall laxity at median follow-up of 16 days. Cryo was applied extra-thoracically in CRE + cryo without thoracoscopy or lung isolation, while MIRPE + CRE + Cryo used a combination extra-/intra-thoracic cryoablation in with thoracoscopy.
Intercostal nerve cryoablation reduces opioid use and LOS in patients undergoing cartilaginous rib excision for slipping rib syndrome. Cryotherapy to as low as T10 did not result in abdominal wall laxity and can be applied extra-thoracically without the need for thoracoscopy. Ongoing prospective studies are required to assess the long-term outcomes.
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微创漏斗胸修复术（MIRPE）和肋软骨切除术（CRE）治疗滑动肋综合征（SRS）是痛苦的手术。肋间神经冷冻消融术（Cryo）可控制疼痛并减少 MIRPE 中的阿片类药物使用。本文介绍了我们在 CRE 中冷冻消融的经验。
对 2018 年至 2022 年间行 CRE 的所有患者进行回顾性图表审查。收集了人口统计学、临床特征、手术细节和住院过程的数据。
共 98 例患者行 CRE：68 例 CRE 无冷冻，22 例 CRE+Cryo，8 例联合 MIRPE+CRE+Cryo。90%的患者行可吸收肋骨板固定。患者主要为女性（分别为 79%、73%、50%），中位年龄分别为 17.6 岁、16.9 岁和 14.2 岁。CRE+Cryo 患者在住院期间使用的阿片类药物明显较少（0.6 OME/kg [0.1，1.2]），而 CRE 无冷冻组（1.0 OME/kg [0.6，2.1]），p<0.05。CRE+Cryo 的中位住院时间（LOS）为 1 天[1，2]，而 CRE 无冷冻组为 2 天[1，2]，p=0.09。MIRPE+CRE+Cryo 患者使用 0.6 OME/kg [0.2，8.0]，住院 2 天[1，5.5]。91%的 Cryo 患者进行了 T9 和/或 T10 肋间神经冷冻消融，中位随访 16 天无腹壁松弛。在 CRE+Cryo 中，冷冻消融是在没有胸腔镜或肺隔离的情况下进行的，而在 MIRPE+CRE+Cryo 中，胸腔镜下采用了胸腔内外冷冻消融相结合的方法。
肋间神经冷冻消融术可减少滑动肋综合征患者行肋软骨切除术后的阿片类药物使用和 LOS。冷冻至 T10 以下不会导致腹壁松弛，可在不进行胸腔镜的情况下进行胸外冷冻。需要进行前瞻性研究来评估长期结果。
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