Aly Mohamed R, Farina Juan M, Botros Michael M, Jaroszewski Dawn E
Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
J Thorac Dis. 2023 Sep 28;15(9):5150-5173. doi: 10.21037/jtd-23-87. Epub 2023 Jun 19.
Pectus excavatum (Pex) is one of the most common congenital deformities of the chest wall, with pectus constituting 90% of all chest wall deformities and excavatum being reported in almost 1:400 to 1:1,000 live births with predominant occurrence in males up to five times more than in females. Depending on the severity, presentation varies from mild cosmetic complaints to life limiting cardiopulmonary symptoms. Patients may develop symptoms as they age, and these symptoms may worsen over the years. A technique for minimally invasive repair for pectus excavatum (MIRPE) was introduced with the concept of temporarily implanting metal bars to correct the deformity. This has rapidly become the standard of care for the pediatric and adolescent patients. The use of MIRPE in adults, however, has been slower to adopt and more controversial. This is largely due to the increased calcification and rigidity of the chest wall in adults which can make the repair more complex and lead to a higher risk of complications. We present a literature review of the presentation, workup, and surgical treatment of adult patients with Pex undergoing MIRPE. Adult patients can, with advanced preoperative evaluations and technique modifications, undergo a highly successful repair resulting in symptom resolution and satisfying results.
漏斗胸（Pex）是最常见的胸壁先天性畸形之一，其中漏斗胸占所有胸壁畸形的90%，据报道，每400至1000例活产儿中就有1例患有漏斗胸，男性发病率是女性的五倍之多。根据严重程度不同，临床表现从轻微的美容问题到危及生命的心肺症状不等。患者可能随着年龄增长出现症状，且这些症状可能会逐年加重。一种漏斗胸微创修复技术（MIRPE）应运而生，其理念是临时植入金属棒来矫正畸形。这已迅速成为儿科和青少年患者的标准治疗方法。然而，MIRPE在成人中的应用发展较慢且更具争议性。这主要是因为成人胸壁钙化增加且变硬，这会使修复更加复杂，并导致更高的并发症风险。我们对接受MIRPE治疗的成年漏斗胸患者的临床表现、检查及外科治疗进行了文献综述。成年患者通过先进的术前评估和技术改良，可以获得非常成功的修复，从而缓解症状并取得满意效果。
