Haller A J, Katlic M, Shermeta D W, Shaker I J, White J J
Ann Surg. 1976 Nov;184(5):554-7. doi: 10.1097/00000658-197611000-00004.
From 1949 to 1975, 220 children have undergone surgical reconstruction of pectus excavatum using a variety of operations on our Pediatric Surgical Service. The first 183 were previously reported and have had subsequent, careful followup evaluation. From 1970 to 1975, an identifiable group of 45 children had a standard operation, a modified Ravitch repair, with the addition of a three-point or tripod internal fixation technique for support of the sternum. These children have all obtained satisfactory reconstruction without prosthetic support of any kind. We have thus avoided the possible danger of foreign material within the chest and have obviated the need for another procedure to remove a supporting stent. The two groups have been analyzed and compared with respect to age distribution, postoperative complications and end results to see if we could detect any trends in the evolving management of children with this condition. The main indications for surgical correction remain cosmetic and postural. Specific trends which have emerged from our experience include an increased percentage of patients between 3 and 8 years of age (average 5.8 years); a decreased need for blood transfusion (10%); a near resolution of postoperative seromas with the use of substernal and subcutaneous suction drains; and in the last 45 children, a 100% excellent or acceptable result to date. We feel that age selection is an important factor in the improved operative result and in the emotional impact on these young patients. Eighty per cent of the children in the recent series were between 3 and 8 years of age at the time of repair. On the basis of this experience, we now feel confident in recommending our standardized operation for pectus excavatum at an elective age of 4 to 6 years.
1949年至1975年期间，在我们的小儿外科服务中，220名儿童接受了各种手术来修复漏斗胸。此前已报道了前183例，并对其进行了后续的仔细随访评估。1970年至1975年期间，有一组45名可识别的儿童接受了标准手术，即改良的拉维奇修复术，并增加了一种三点或三脚架内固定技术来支撑胸骨。这些儿童均获得了满意的修复效果，无需任何假体支撑。因此，我们避免了胸部内有异物的潜在危险，也无需进行另一次手术来取出支撑支架。对这两组儿童在年龄分布、术后并发症和最终结果方面进行了分析和比较，以查看我们是否能在这种疾病的儿童不断发展的治疗中发现任何趋势。手术矫正的主要指征仍然是美容和姿势方面。从我们的经验中出现的具体趋势包括：3至8岁（平均5.8岁）的患者百分比增加；输血需求减少（10%）；使用胸骨后和皮下引流管后，术后血清肿几乎消失；在最后45名儿童中，迄今为止100%的结果为优秀或可接受。我们认为年龄选择是改善手术结果以及对这些年轻患者的情感影响的一个重要因素。在最近一组病例中，80%的儿童在修复时年龄在3至8岁之间。基于这一经验，我们现在有信心推荐在4至6岁的择期年龄对漏斗胸进行我们的标准化手术。
