Zou Chen,Tan Zheng.Mini-invasive Abramson’s surgery for pectus excavatum[J].Journal of Clinical Pediatric Surgery,2023,22(06):525-528.[doi:10.3760/cma.j.cn101785-202302038-005]
微创胸骨沉降术治疗小儿鸡胸
- Title:
- Mini-invasive Abramson’s surgery for pectus excavatum
- Keywords:
- Pectus Carinatum; Minimally Invasive Surgical Procedures; Orthopedic Procedures; Treatment Outcome
- 摘要:
- 目的 总结微创胸骨沉降术（Abramson术）治疗小儿鸡胸的临床经验。方法 回顾性分析2019年1月至2023年2月浙江大学医学院附属儿童医院收治的141例行微创胸骨沉降术治疗的鸡胸患儿临床资料，收集所有患儿手术情况及治疗结果。结果 所有患儿均顺利完成手术，手术时间（52.9±21.7） min，术中出血量（2.7±1.8） mL。住院时间（7.4±2.1） d。所用矫形钢板长度为25.4~33.0 cm。患儿术后均外观良好，顺利恢复正常活动，无不适，患儿和家属对矫形效果满意。无一例出现严重并发症。其中85例已完成钢板拆除，钢板拆除时间术后（18.3±7.3）个月，钢板取出后胸廓保持良好，无一例复发。结论 微创胸骨沉降术治疗小儿鸡胸具有安全、美观、创伤小、恢复快、复发率低等优势，应选择合适年龄和有较强手术意愿的患儿进行手术。
- Abstract:
- Objective To summarize our clinical experiences of mini-invasive surgery for pectus excavatum (PE) in children.Methods From January 2019 to February 2023, retrospective analysis was performed for clinical data of 141 PE children undergoing mini-invasive surgical repair with a modified Nuss procedure.Results All operations were successfully completed with a mean operative duration of (52.9±21.7) min and a mean intraoperative volume of blood loss (2.7±1.8) ml.The mean hospital stay was (7.4±2.1) days.And the usage length of correction bar ranged from 10 inches (25.4 cm) to 13 inches (33.0 cm).They maintained an excellent appearance, resumed normal activities and had no discomfort.The children and their families were satisfied with the correction outcomes.There were no serious postoperative complications.Among them, 85 cases had a removal of correction bar with a mean removal time of (18.3±7.3) month.Chest wall regained an excellent appearance without any recurrence after removal.Conclusion Mini-invasive modified Nuss procedure for PE offers the advantages of safety, aesthetics, minimal trauma, quick recovery and low recurrence rate in children.Selecting appropriate patients with a stronger surgical aspiration is vital for successful surgery.
参考文献/References:
[1] de Souza Coelho M, de Souza Coelho M.Pectus carinatum[J].J Bras Pneumol, 2007, 33(4):463-474.DOI:10.1590/s1806-37132007000400017.
[2] Kuru P, Cakiroglu A, Er A, et al.Pectus excavatum and pectus carinatum:associated conditions, family history, and postoperative patient satisfaction[J].Korean J Thorac Cardiovasc Surg, 2016, 49(1):29-34.DOI:10.5090/kjtcs.2016.49.1.29.
[3] Robicsek F, Watts LT.Pectus carinatum[J].Thorac Surg Clin, 2010, 20(4):563-574.DOI:10.1016/j.thorsurg.2010.07.007.
[4] Fonkalsrud EW.Surgical correction of pectus carinatum:lessons learned from 260 patients[J].J Pediatr Surg, 2008, 43(7):1235-1243.DOI:10.1016/j.jpedsurg.2008.02.007.
[5] Steinmann C, Krille S, Mueller A, et al.Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image:a control group comparison of psychological characteristics prior to surgical correction[J].Eur J Cardiothorac Surg, 2011, 40(5):1138-1145.DOI:10.1016/j.ejcts.2011.02.019.
[6] Knudsen MV, Grosen K, Pilegaard HK, et al.Surgical correction of pectus carinatum improves perceived body image, mental health and self-esteem[J].J Pediatr Surg, 2015, 50(9):1472-1476.DOI:10.1016/j.jpedsurg.2014.11.048.
[7] Fonkalsrud EW, Anselmo DM.Less extensive techniques for repair of pectus carinatum:the undertreated chest deformity[J].J Am Coll Surg, 2004, 198(6):898-905.DOI:10.1016/j.jamcollsurg.2004.02.016.
[8] 刘青, 吴晔明.鸡胸的治疗进展[J].临床小儿外科杂志, 2013, 12(1):64-66, 75.DOI:10.3969/j.issn.1671-6353.2013.01.020. Liu Q, Wu YM.Therapeutic advances of chicken breasts[J].J Clin Ped Sur, 2013, 12(1):64-66, 75.DOI:10.3969/j.issn.1671-6353.2013.01.020.
[9] Loff S, Sauter H, Wirth T, et al.Highly efficient conservative treatment of pectus carinatum in compliant patients[J].Eur J Pediatr Surg, 2015, 25(5):421-424.DOI:10.1055/s-0034-1384648.
[10] Suh JW, Joo S, Lee GD, 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.
[11] Ravitch MM.Unusual sternal deformity with cardiac symptoms operative correction[J].J Thorac Surg, 1952, 23(2):138-144.
[12] Ravitch MM.Operative correction of pectus carinatum (pigeon breast)[J].Ann Surg, 1960, 151(5):705-714.DOI:10.1097/00000658-196005000-00011.
[13] Abramson H.A minimally invasive technique to repair pectus carinatum.Preliminary report[J].Arch Bronconeumol, 2005, 41(6):349-351.DOI:10.1016/S1579-2129(06)60235-8.
[14] Abramson H, D’Agostino J, Wuscovi S.A 5-year experience with a minimally invasive technique for pectus carinatum repair[J].J Pediatr Surg, 2009, 44(1):118-124.DOI:10.1016/j.jpedsurg.2008.10.020.
[15] Bilgin M, Oral A.Early results of minimal invasive surgery in patients with pectus carinatum[J].Turk Gogus Kalp Damar Cerrahisi Derg, 2012, 20(2):307-311.DOI:10.5606/tgkdc.dergisi.2012.058.
[16] Yuksel M, Lacin T, Ermerak NO, et al.Minimally invasive repair of pectus carinatum[J].Ann Thorac Surg, 2018, 105(3):915-923.DOI:10.1016/j.athoracsur.2017.10.003.
[17] 曾骐, 贺延儒, 李士惠.小儿鸡胸的分型及外科治疗[J].中华胸心血管外科杂志, 1999, 15(4):225-227.DOI:10.3760/cma.j.issn.1001-4497.1999.04.011. Zeng Q, He YR, Li SH.Types and surgical corrections of pectus carinatum in children[J].Chin J Thorac Cardiovasc Surg, 1999, 15(4):225-227.DOI:10.3760/cma.j.issn.1001-4497.1999.04.011.
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备注/Memo
收稿日期:2023-02-25。
基金项目:2022年度浙江省中医药科学研究基金项目（2022ZB210）
通讯作者:谭征,Email:tanzheng@zju.edu.cn