Individualised treatment of pectus carinatum combined with Haversian sulcus depression
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摘要:
目的 探讨微创胸骨沉降术联合Nuss术治疗鸡胸合并哈氏沟凹陷的可行性。 方法 收集2015年6月—2020年8月安徽省儿童医院胸外科收治鸡胸合并哈氏沟凹陷行微创胸骨沉降术联合Nuss术的个体化治疗患儿的临床资料，包括：Haller指数、手术时间、术中出血量、术后住院时间、术后并发症、家属满意度等，对这些资料进行描述分析。 结果 本研究共收集45例鸡胸合并哈氏沟凹陷患儿临床资料，其中男43例，女2例，年龄为8~18(12.98±1.80)岁，体重为23.00~68.50(44.58±8.60)kg，测量Haller指数为1.69~2.27(2.12±0.15)。所有患儿均顺利完成手术，手术时间为107~208(181.89±32.61)min，术中出血量为5~20(10.58±2.58)mL，术后家属对患儿胸廓外观改善的满意率在95%以上，无严重手术并发症，其中1例患者切口感染，定期换药后逐渐愈合。术后1、4、12、24个月定期复查，其中22例已取出内固定支架，取出支架后1个月~1年随访，无复发表现。 结论 微创胸骨沉降术联合Nuss术的个体化方案，适用于治疗鸡胸合并哈氏沟凹陷患儿，不仅能最大限度地改善胸壁外观，而且可以增加胸腔容积，值得推广应用。 Abstract:Objective To explore the feasibility of minimally invasive sternal sedimentation combined with Nuss procedure in the treatment of pectus carinatum with Haversian sulcus depression. Methods We collected the clinical data of children treated with minimally invasive sternal sedimentation combined with Nuss procedure for pectus carinatum with Haversian sulcus depression during June 2015 to August 2020. Then, we described and analysed their information such as Haller index, operative time, intraoperative blood loss, postoperative hospitalisation time, postoperative complications and family satisfaction. Results A total of 45 cases with pectus carinatum with Haversian sulcus depression were collected. Amongst them, 43 were boys, and 2 were girls. Their age ranged from 8 to 18 years [average age (12.98±1.80) years]. Their weight ranged from 23.00 to 28.50 kg [(44.58±8.60) kg]. Their Haller index ranged from 1.69 to 2.27 (2.12±0.15). The surgery was successfully performed in all patients. The surgery time ranged from 107 to 208 min [(181.89±32.61) min]. Intraoperative bleeding was between 5 mL and 20 mL [(10.58±2.58) mL]. The satisfaction rate was >95%. No severe surgical complications were noted. Infection at the incision site in one patient was treated with regular changing of wound dressing. We followed up the patients for 1, 4, 12 and 24 months after surgery. There are 22 patients removed their internal support at present. During the follow-up period, no recurrence was observed. Conclusion Individualised minimally invasive sternal sedimentation combined with Nuss procedure is suitable for the treatment of pectus carinatum with Haversian sulcus depression. It not only improves the chest wall appearance, but also increases the volume of the chest. Thus, it is worth popularising and applying. -
[1] MUNTEAN A, STOICA I, SAXENA A K. Pigeon chest: Comparative analysis of surgical techniques in minimal access repair of pectus carinatum (MARPC)[J]. World J Pediatr, 2018, 14(1): 18-25. doi: 10.1007/s12519-018-0121-2 [2] BAHADIR A T, KURU P,ÇAKIROǦLU A, et al. Psychosocial functioning in pediatric patients with pectus excavatum and pectus carinatum[J]. Turk J Med Sci, 2017, 47(3): 771-777. http://online.journals.tubitak.gov.tr/openAcceptedDocument.htm?fileID=801260&no=189990 [3] DURAMAZ A, YILMAZ S, ZIROGǦLU N, et al. The effect of deformity correction on psychiatric condition of the adolescent with adolescent idiopathic scoliosis[J]. Eur Spine J, 2018, 27(9): 2233-2240. doi: 10.1007/s00586-018-5639-4 [4] CHEN C, ZENG Q, LI Z, et al. Force required for correcting the deformity of pectus carinatum and related multivariate analysis[J]. J Pediatr Surg, 2018, 53(9): 1855-1857. doi: 10.1016/j.jpedsurg.2017.12.013 [5] DEL FRARI B, SIGL S, SCHWABEGGER A H. Complications related to pectus carinatum correction: Lessons learned from 15 years' experience. Management and literature review[J]. Plast Reconstr Surg, 2016, 138(2): 317e-329e. doi: 10.1097/PRS.0000000000002414 [6] FORTMANN C, PETERSEN C. Surgery for Deformities of the Thoracic Wall: No more than strengthening the patient's self-esteem?[J]. Eur J Pediatr Surg, 2018, 28(4): 355-360. doi: 10.1055/s-0038-1668131 [7] ABRAMSON H. A minimally invasive technique to repair pectus carinatum. Preliminary report[J]. Arch Bronconeumol, 2005, 41(6): 349-351. doi: 10.1157/13076004 [8] YUKSEL M, LACIN T, ERMERAK N O, et al. Minimally invasive repair of pectus carinatum[J]. Ann Thoracic Surg, 2018, 105(3): 915-923. doi: 10.1016/j.athoracsur.2017.10.003 [9] ÖZKAYA M, BILGIN M. Minimally invasive repair of pectus carinatum by modification of the Abramson technique[J]. Wideochir Inne Tech Maloinwazyjne, 2018, 13(3): 383-387. http://www.ncbi.nlm.nih.gov/pubmed/30302152 [10] PARK H J, KIM K S. The sandwich technique for repair of pectus carinatum and excavatum/carinatum complex[J]. Ann Cardiothorac Surg, 2016, 5(5): 434-439. doi: 10.21037/acs.2016.08.04 [11] 段贤伦, 章鹏, 商子寅, 等. 鸡胸微创外科治疗59例报告[J]. 中国微创外科杂志, 2017, 17(9): 818-821, 826. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWWK201709016.htm [12] SUH J W, JOO S, LEE G D, et al. Minimally invasive repair of pectus carinatum in patients unsuited to bracing therapy[J]. Korean J Thorac Cardiovasc Surg, 2016, 49(2): 92-98. doi: 10.5090/kjtcs.2016.49.2.92 [13] 张鸿. 反NUSS手术治疗小儿鸡胸15例体会[J]. 中国临床新医学, 2019, 12(6): 660-662. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLN201906021.htm [14] SIGL S, DEL FRARI B, HARASSER C, et al. The effect on cardiopulmonary function after thoracoplasty in pectus carinatum: A systematic literature review[J]. Interact Cardio Vasc Thorac Surg, 2018, 26(3): 474-479. doi: 10.1093/icvts/ivx353 [15] KNUDSEN M V, PILEGAARD H K, GROSEN K. Pain and sensory disturbances following surgical repair of pectus carinatum[J]. J Pediatr Surg, 2018, 53(4): 733-739. doi: 10.1016/j.jpedsurg.2017.08.015 [16] 赵富东, 储生雷, 赵玉彪, 等. 用Nuss胸廓成形术治疗大龄儿童鸡胸的可行性研讨[J]. 当代医药论丛, 2018, 16(19): 42-43. https://www.cnki.com.cn/Article/CJFDTOTAL-QYWA201819027.htm [17] 纪红蕾, 王君臣, 陈诚豪, 等. 基于改进型Haller指数的儿童鸡胸自动化诊断[J]. 生物医学工程学杂志, 2018, 35(4): 571-577. https://www.cnki.com.cn/Article/CJFDTOTAL-SWGC201804010.htm [18] 陈诚豪, 王君臣, 张娜, 等. 有限元分析法在鸡胸微创手术模拟中的应用[J]. 中华小儿外科杂志, 2018, 39(9): 665-669. [19] 李小军, 朱潇, 杏福宝, 等. 三维重建及3D打印在微创肺外科中的应用[J]. 中华全科医学, 2020, 18(7): 1190-1194. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202007035.htm [20] 张文园, 刘雪莹, 王福. 生物医学图像三维重建技术应用研究进展[J]. 中华实用诊断与治疗杂志, 2016, 30(7): 629-631. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD201607002.htm -
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