Ichiki Yoshinobu, Saito Nako, Yamaki Ei, Ito Tomokazu
Department of General Thoracic Surgery, Fukaya Red Cross Hospital, Fukaya, Japan.
Department of General Thoracic Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
AME Case Rep. 2025 Jul 15;9:97. doi: 10.21037/acr-25-23. eCollection 2025.
The Nuss procedure is a minimally invasive surgical procedure for treating pectus excavatum. Recently, its application has been extended to flail chest.
A 72-year-old woman presented to the emergency department with ventricular fibrillation caused by acute myocardial infarction. The patient underwent cardiac catheterization and coronary artery stenting following cardiopulmonary resuscitation (CPR). The patient was referred to Fukaya Red Cross Hospital owing to dyspnea caused by a flail chest following CPR. Being an elderly woman, the supporting tissues of the thorax had weakened, and she had a pronounced flail chest, a labored breathing pattern, and severe respiratory distress. Although there is the disadvantage that cardiac massage would become difficult, the cardiologist determined that cardiac function had stabilized after stent placement and that the likelihood of cardiac massage being necessary was extremely low, and therefore it was determined that repair using the Nuss method would be preferable. Two Nuss bars were inserted. Following the procedure, her respiratory condition improved, and she was discharged. Eight months later, the collapse of the anterior chest wall had resolved, and the Nuss bars were removed. However, the patient developed bilateral pneumothoraces post-removal. Thoracic drainage was performed, leading to improvement, and she was subsequently discharged.
This is a rare case of using the Nuss procedure to treat flail chest following CPR. Despite the occurrence of bilateral pneumothorax after Nuss bar removal, the patient's respiratory condition significantly improved, and she had a favorable prognosis.
努斯手术是一种用于治疗漏斗胸的微创手术。最近，其应用已扩展至连枷胸。
一名72岁女性因急性心肌梗死导致心室颤动被送至急诊科。患者在心肺复苏（CPR）后接受了心脏导管插入术和冠状动脉支架置入术。由于CPR后出现连枷胸导致呼吸困难，该患者被转诊至深谷红十字医院。作为一名老年女性，其胸部支撑组织已经减弱，她存在明显的连枷胸、呼吸模式费力以及严重的呼吸窘迫。尽管存在心脏按压会变得困难这一缺点，但心脏病专家确定支架置入后心脏功能已稳定，且心脏按压的必要性极低，因此确定采用努斯方法进行修复更为可取。插入了两根努斯棒。术后，她的呼吸状况有所改善并出院。八个月后，前胸壁塌陷得到解决，努斯棒被取出。然而，患者在取出努斯棒后出现双侧气胸。进行了胸腔引流，病情好转，随后她出院了。
这是一例罕见的使用努斯手术治疗CPR后连枷胸的病例。尽管在取出努斯棒后出现了双侧气胸，但患者的呼吸状况显著改善，且预后良好。
