接受改良Ravitch技术修复漏斗胸患者的功能和美学效果
Functional and Aesthetic Outcomes of Patients Underwent Modified Ravitch Technique for Repair of Pectus Excavatum.
作者信息
A Farag Gamal, M Omran Ahmed, H Youssif Sherif, S Abd Alaziz Ramadan, A Nematallah Samir, B Abd El Salam Ahmed, F El Boraey Husseini, I Ramadan Osama, Zahra Tarek, M Zeina Ahmed
机构信息
Department of Cardiothoracic Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt.
Department of Plastic and Reconstructive Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt.
出版信息
Med J Islam Repub Iran. 2024 Aug 20;38:95. doi: 10.47176/mjiri.38.95. eCollection 2024.
BACKGROUND
Pectus excavatum is the most frequent congenital defect of the chest wall. Surgical treatment with modified Ravitch-type repair is recommended in patients with cosmetic dissatisfaction or considerable cardiopulmonary symptoms. We aimed to analyze the surgical, aesthetic, cardiopulmonary functions and patient satisfaction outcomes of modified Ravitch repair pre and postoperatively.
METHODS
This was a prospective analysis of 13 pectus excavatum patients undergoing repair by modified Ravitch using a permanent titanium plate fixed with a screw from September 2021 to August 2023. Patients were included to relieve pressure on the heart and lungs if complaining of exercise intolerance, cosmetic impairment, shortness of breathing, chest pain, or psychological disturbance with an age range from 10 years to 30 years old. While patients who had received conservative or surgical treatment previously or patients with scoliosis, Marfan syndrome or bronchial asthma were excluded. At the 6-month postoperative visit, a postoperative satisfaction survey was conducted.
RESULTS
The means of the age of patients (16.4 ± 2.36 years); operative duration (120 minutes); blood loss (200± 15.47 mL) and Haller index was (3.8± 0.35) preoperatively compared with less than 3.0 (2.7± 0.08 postoperatively; hospital stay (7 days). The most frequent complications were seroma in one patient (7.69%), postoperative bleeding in one patient (7.69%) and skin infection in one patient (7.69%) of patients. No recorded infection of the sternal plate or required operative re-exploration for infection. All patients were subjectively satisfied with the excellent surgical results. Exercise intolerance despite increased exercise performance was observed following surgery, including less sensation of dyspnea.
CONCLUSION
Modified Ravitch-type repair is a secure and reliable method for treating pectus excavatum with better relief of preoperative symptoms.
背景
漏斗胸是最常见的胸壁先天性缺陷。对于有美容方面不满或有明显心肺症状的患者，建议采用改良Ravitch式修复进行手术治疗。我们旨在分析改良Ravitch修复术前和术后的手术效果、美学效果、心肺功能及患者满意度。
方法
这是一项对2021年9月至2023年8月期间13例接受改良Ravitch修复术的漏斗胸患者进行的前瞻性分析，手术采用永久钛板并用螺钉固定。纳入年龄在10岁至30岁之间、主诉运动不耐受、美容缺陷、呼吸急促、胸痛或心理障碍以缓解心肺压力的患者。排除先前接受过保守或手术治疗的患者，以及患有脊柱侧弯、马凡综合征或支气管哮喘的患者。术后6个月随访时进行术后满意度调查。
结果
患者术前平均年龄（16.4±2.36岁）；手术时长（120分钟）；失血量（200±15.47毫升）以及Haller指数为（3.8±0.35），术后分别为低于3.0（2.7±0.08）；住院时间（7天）。最常见的并发症为1例患者出现血清肿（7.69%），1例患者术后出血（7.69%），1例患者皮肤感染（7.69%）。未记录到胸骨板感染或因感染需要再次手术探查的情况。所有患者对出色的手术效果主观上均感到满意。术后尽管运动能力有所提高，但仍观察到运动不耐受，包括呼吸困难感减轻。
结论
改良Ravitch式修复是治疗漏斗胸的一种安全可靠的方法，能更好地缓解术前症状。
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