Morshuis W, Folgering H, Barentsz J, van Lier H, Lacquet L
Department of Thoracic and Cardiac Surgery, University Hospital Nijmegen, The Netherlands.
Chest. 1994 Jun;105(6):1646-52. doi: 10.1378/chest.105.6.1646.
Pulmonary function tests were performed before surgery on 152 patients who were operated on for pectus excavatum between 1970 and 1987 and at long-term follow-up to assess the degree of impairment and to investigate any changes caused by surgical correction. The mean age at surgery was 15.3 +/- 5.5 years. Pulmonary function was found to be restricted preoperatively. Multivariate analysis showed that preoperative pulmonary function was not related to age, the severity of the deformity at physical examination, or to pulmonary complaints. Only the patients with obstructive disease showed significantly more pulmonary complaints (p = 0.042). The total lung capacity (TLC) and inspiratory vital capacity (IVC) were significantly related to the age-corrected (delta) anteroposterior diameter of the chest (lower vertebral index [LVI]) (p = 0.0001). At follow-up (mean, 8.1 +/- 3.6 years), the restriction of pulmonary function was increased despite improvement in the symptoms of most patients and despite a significant increase in the anteroposterior diameter of the chest (p = 0.0001): the TLC was decreased from 83.7 percent predicted (pred) preoperatively to 73.8 percent pred (p = 0.0001) and the IVC from 78.3 percent pred to 70.7 percent pred (p = 0.0001). The surgical results were satisfactory in 83.6 percent. No relation was found between the changes in pulmonary function measured at follow-up and the surgical results. Only the age at surgery and the changes in the TLC and IVC at follow-up were significantly related (p = 0.0036, 0.0043, respectively), although the correlation coefficients were low (r = 27 percent and 28 percent, respectively). The reduction in lung function at follow-up was most pronounced in the patients who had the least functional impairment (TLC > 75 percent pred) preoperatively. No correlation was found between the changes in the pulmonary function test results at follow-up and follow-up interval, preoperative delta LVI, and the change in delta LVI at follow-up.
对1970年至1987年间接受漏斗胸手术的152例患者在手术前进行了肺功能测试，并进行长期随访，以评估损伤程度并调查手术矫正引起的任何变化。手术时的平均年龄为15.3±5.5岁。术前发现肺功能受限。多变量分析显示，术前肺功能与年龄、体格检查时畸形的严重程度或肺部症状无关。只有患有阻塞性疾病的患者肺部症状明显更多（p = 0.042）。总肺容量（TLC）和吸气肺活量（IVC）与经年龄校正的胸部前后径（下椎体指数[LVI]）显著相关（p = 0.0001）。在随访时（平均8.1±3.6年），尽管大多数患者症状有所改善且胸部前后径显著增加（p = 0.0001），但肺功能受限仍有所加重：TLC从术前预测值的83.7%降至预测值的73.8%（p = 0.0001），IVC从预测值的78.3%降至预测值的70.7%（p = 0.0001）。手术结果在83.6%的患者中令人满意。随访时测得的肺功能变化与手术结果之间未发现相关性。只有手术时的年龄以及随访时TLC和IVC的变化显著相关（分别为p = 0.0036和0.0043），尽管相关系数较低（分别为r = 27%和28%）。随访时肺功能下降在术前功能损害最小（TLC>预测值的75%）的患者中最为明显。随访时肺功能测试结果的变化与随访间隔、术前LVI变化以及随访时LVI变化之间未发现相关性。
