van Braak Hendrik, de Beer Sjoerd A, Al Ghouch Youssef, Zwaveling Sander, Oomen Matthijs W N, van Heurn L W Ernest, de Jong Justin R
Department of Pediatric Surgery, Emma Kinderziekenhuis, Amsterdam University Medical Center, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
Department of Pediatric Surgery, Emma Kinderziekenhuis, Amsterdam University Medical Center, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
J Pediatr Surg. 2025 Feb;60(2):161891. doi: 10.1016/j.jpedsurg.2024.161891. Epub 2024 Sep 1.
Long-term results and factors affecting outcomes of vacuum bell therapy for pectus excavatum are relatively unknown.
We conducted a retrospective study on patients (<18y) treated with vacuum bell therapy between May 2008 and October 2021. Primary outcome was treatment success; secondary outcomes were analysis of daily time spent on treatment, treatment duration, complications, long-term follow-up, treatment for patients awaiting a Nuss procedure, treatment for female patients, and factors affecting outcomes.
Of 259 patients treated with vacuum bell therapy, 18.9% (n = 49/259) were still being treated, 17.4% (n = 45/259) were lost to follow-up and 63.7% (n = 165/259) completed treatment, with a 52.1% (n = 86/165) success rate. Median follow-up was 64.0 months (interquartile range 48.0-87.0). More time spent daily on vacuum bell therapy, total treatment duration, and overnight use led to a higher success rate (P = 0.002, P < 0.001, P < 0.001 resp.). Complications (22.8%, n = 59/259) were minor, recurrence occurred in 2.3% (n = 2/86) of patients. Of the patients treated while awaiting a Nuss procedure, 26.7% (n = 4/15) no longer required the Nuss procedure. Breast growth made 39.3% (n = 11/28) of female patients quit treatment. Deeper deformities (P = 0.02, P = 0.009), flexible chest wall (P = 0.007) and symptomatic pectus excavatum (P = 0.02) resulted in lower success rates.
Vacuum bell therapy is successful in up to 52.1% of patients. Overnight vacuum bell use and treatment while awaiting a Nuss procedure should be encouraged. Older patients with a stiff chest wall can be successfully treated with prolonged treatment. For female patients watchful waiting or early treatment, to prevent challenges during breast growth, is preferred.
Level II.
漏斗胸真空吸盘治疗的长期效果及影响预后的因素尚不清楚。
我们对2008年5月至2021年10月期间接受真空吸盘治疗的患者（<18岁）进行了一项回顾性研究。主要结局是治疗成功；次要结局包括分析每日治疗时间、治疗持续时间、并发症、长期随访、等待Nuss手术患者的治疗、女性患者的治疗以及影响预后的因素。
在259例接受真空吸盘治疗的患者中，18.9%（n = 49/259）仍在接受治疗，17.4%（n = 45/259）失访，63.7%（n = 165/259）完成治疗，成功率为52.1%（n = 86/165）。中位随访时间为64.0个月（四分位间距48.0 - 87.0）。每日在真空吸盘治疗上花费更多时间、总治疗持续时间以及夜间使用导致更高的成功率（分别为P = 0.002、P < 0.001、P < 0.001）。并发症发生率为22.8%（n = 59/259），程度较轻，2.3%（n = 2/86）的患者出现复发。在等待Nuss手术期间接受治疗的患者中，26.7%（n = 4/15）不再需要Nuss手术。乳房发育导致39.3%（n = 11/28）的女性患者停止治疗。畸形程度更深（P = 0.02，P = 0.009）、胸壁柔韧性好（P = 0.007）以及有症状的漏斗胸（P = 0.02）导致成功率较低。
真空吸盘治疗在高达52.1%的患者中取得成功。应鼓励夜间使用真空吸盘以及在等待Nuss手术期间进行治疗。胸壁僵硬的年长患者通过延长治疗可成功治愈。对于女性患者，建议密切观察或早期治疗，以避免乳房发育期间出现问题。
二级。
