Clinical effects of thoracoscopy-assisted modified Nuss procedure on children with pectus excavatum

doi:10.3877/cma.j.issn.1673-5250.2022.02.015

Objective

To investigate clinical effects of thoracoscopic modified Nuss procedure in the treatment of pectus excavatum.

Methods

From January 2012 to December 2019, 174 children with pectus excavatum who underwent thoracoscopic modified Nuss procedure in the First Affiliated Hospital, Xinjiang Medical University were selected into this study (study group). Another 37 children with pectus excavatum who underwent traditional sternal turnover surgery from January 2002 to January 2010 in the same hospital were enrolled into control group. The Haller index of two groups were 3.76-11.23 and 3.28-18.30, respectively. Age, Haller index and operation duration were statistically analyze by independent-samples t test. Length of stay was statistically analyzed by rank sum test. Comparisons of gender ratio, complication rates and recurrence rates between two groups were performed by chi-square test. The procedures followed in this study were conformed to requirements of World Medical Association Declaration of Helsinki revised in 2013. For all participants, written informed consent was obtained from both parents regarding participation of child/adolescent and one from the participating parent.

Results

①There were no significant differences between two groups in composition ratio of gender, age and Haller index (P>0.05). ②The operation duration [(26.6±4.5) min] and length of stay [8.0 d (7.0-9.8 d)] in study group were shorter than those in control group[(135.0±24.2) min, 39.0 d(37.0-42.8 d)], and the differences between two groups were statistically significant (t=21.441, Z=35.748; P<0.001). Besides, the complication rate [8.6%(15/174)] and recurrence rate (0) in study group were lower than those in control group [24.3% (9/174), 18.9% (7/37)], and the differences between two groups were statistically significant (χ²=5.988, P=0.014; 28.406, <0.001). ③ Of these 15 children (8.6%, 15/174) in study group who had complications, 1, 10, and 4 children were during intraoperative, early postoperative (≤30 d), and late postoperative (>30 d), respectively. ④ Patients in two groups were followed-up for 2 months to 7 years after surgery, and the satisfaction degree in study group (98.3%, 171/174) was higher than that in control group (91.9%, 34/37), and the difference was statistically significant (χ²=4.501, P=0.034).

Conclusions

Thoracoscopic modified Nuss procedure for pectus excavatum has the advantages of simple operation, short operation duration, small and hidden incision, quick postoperative recovery, and high satisfaction.

Key words: Funnel chest, Sternal turnover surgery, Thoracoscopes, Modified Nuss procedure, Recurrence, Postoperative complications, Patient satisfaction, Child

表1 2组漏斗胸患儿一般临床资料比较

组别	例数	性别[例数(%)]		年龄(岁，±s)	Haller指数(±s)
组别	例数	男	女	年龄(岁，±s)	Haller指数(±s)
研究组	174	151(86.8)	23(13.2)	9.2±4.9	4.4±1.2
对照组	37	28(75.7)	9(24.3)	9.9±3.3	4.5±1.3
检验值		χ²＝2.931		t＝1.112	t＝0.521
P值		0.087		0.272	0.606

表1 2组漏斗胸患儿一般临床资料比较

组别	例数	性别[例数(%)]		年龄(岁，±s)	Haller指数(±s)
组别	例数	男	女	年龄(岁，±s)	Haller指数(±s)
研究组	174	151(86.8)	23(13.2)	9.2±4.9	4.4±1.2
对照组	37	28(75.7)	9(24.3)	9.9±3.3	4.5±1.3
检验值		χ²＝2.931		t＝1.112	t＝0.521
P值		0.087		0.272	0.606

表2 研究组174例不同民族漏斗胸患儿临床特征及术后恢复时间

民族	例数	性别[例数(%)]		平均身高(cm)	平均体重(kg)	出现体征平均年龄(岁)	平均就诊年龄(岁)	术后恢复时间(年)
民族	例数	男	女	平均身高(cm)	平均体重(kg)	出现体征平均年龄(岁)	平均就诊年龄(岁)	术后恢复时间(年)
维吾尔族	94	81(86.2)	13(13.8)	137.4	35.4	4.4	15.42	3.45
汉族	45	36(80.0)	9(20.0)	135.7	32.8	3.2	9.85	2.56
哈萨克族	18	18(100.0)	0(0)	136.2	36.2	4.3	11.45	3.38
柯尔克孜族	7	7(100.0)	0(0)	139.3	34.9	3.7	10.35	2.74
回族	5	4(80.0)	1(20.0)	134.1	33.2	4.4	9.70	3.50
蒙古族	2	2(100.0)	0(0)	142.5	36.5	4.0	12.50	2.60
塔吉克族	2	2(100.0)	0(0)	139.2	34.5	3.5	10.50	3.14
东乡族	1	1(100.0)	0(0)	137.0	34.5	4.0	12.00	2.40

表2 研究组174例不同民族漏斗胸患儿临床特征及术后恢复时间

民族	例数	性别[例数(%)]		平均身高(cm)	平均体重(kg)	出现体征平均年龄(岁)	平均就诊年龄(岁)	术后恢复时间(年)
民族	例数	男	女	平均身高(cm)	平均体重(kg)	出现体征平均年龄(岁)	平均就诊年龄(岁)	术后恢复时间(年)
维吾尔族	94	81(86.2)	13(13.8)	137.4	35.4	4.4	15.42	3.45
汉族	45	36(80.0)	9(20.0)	135.7	32.8	3.2	9.85	2.56
哈萨克族	18	18(100.0)	0(0)	136.2	36.2	4.3	11.45	3.38
柯尔克孜族	7	7(100.0)	0(0)	139.3	34.9	3.7	10.35	2.74
回族	5	4(80.0)	1(20.0)	134.1	33.2	4.4	9.70	3.50
蒙古族	2	2(100.0)	0(0)	142.5	36.5	4.0	12.50	2.60
塔吉克族	2	2(100.0)	0(0)	139.2	34.5	3.5	10.50	3.14
东乡族	1	1(100.0)	0(0)	137.0	34.5	4.0	12.00	2.40

图6 研究组1例漏斗胸患儿(女性，16岁)行胸腔镜辅助微创手术(改良型Nuss术)后胸部X射线摄片("T"型固定器须骑到双侧相对应肋骨上)

表3 2组漏斗胸患儿手术情况比较

组别	例数	手术持续时间(min，±s)	住院时间[d，M(P₂₅~P₇₅)]	并发症[例数(%)]	复发率[例数(%)]
研究组	174	26.6±4.5	8.0(7.0~9.8)	15(8.6)	0(0)
对照组	37	135.0±24.2	39.0(37.0~42.8)	9(24.3)	7(18.9)
检验值		t＝21.441	Z＝35.748	χ²＝5.988^a	χ²＝28.406^a
P值		<0.001	<0.001	0.014	<0.001

表3 2组漏斗胸患儿手术情况比较

组别	例数	手术持续时间(min，±s)	住院时间[d，M(P₂₅~P₇₅)]	并发症[例数(%)]	复发率[例数(%)]
研究组	174	26.6±4.5	8.0(7.0~9.8)	15(8.6)	0(0)
对照组	37	135.0±24.2	39.0(37.0~42.8)	9(24.3)	7(18.9)
检验值		t＝21.441	Z＝35.748	χ²＝5.988^a	χ²＝28.406^a
P值		<0.001	<0.001	0.014	<0.001

表4 研究组174例漏斗胸患儿术后并发症及转归

并发症		发生率[例数(%)]	处理及转归
术中
	肺下静脉损伤	1(0.57)	严重不对称型漏斗胸术中损伤，给予肺下静脉术中修补处理，痊愈出院
术后早期(≤30 d)
	双侧或单侧气胸	7(4.02)	5例置入胸腔闭式引流管，2例气胸面积<10%，自行吸收治愈
	胸腔积液	2(1.14)	置入胸腔闭式引流管，痊愈出院
	钢板排斥反应	1(0.57)	观察25 d排斥反应未改善，行钢板取出术，漏斗胸得到一定程度矫形
术后后期(>30 d)
	术后切口感染	2(1.14)	钢板磨损皮肤并穿破引起局部感染，给予清创缝合处理
	钢板移位	2(1.14)	2次手术矫形并予以肋骨固定钢板，矫形满意

表4 研究组174例漏斗胸患儿术后并发症及转归

并发症		发生率[例数(%)]	处理及转归
术中
	肺下静脉损伤	1(0.57)	严重不对称型漏斗胸术中损伤，给予肺下静脉术中修补处理，痊愈出院
术后早期(≤30 d)
	双侧或单侧气胸	7(4.02)	5例置入胸腔闭式引流管，2例气胸面积<10%，自行吸收治愈
	胸腔积液	2(1.14)	置入胸腔闭式引流管，痊愈出院
	钢板排斥反应	1(0.57)	观察25 d排斥反应未改善，行钢板取出术，漏斗胸得到一定程度矫形
术后后期(>30 d)
	术后切口感染	2(1.14)	钢板磨损皮肤并穿破引起局部感染，给予清创缝合处理
	钢板移位	2(1.14)	2次手术矫形并予以肋骨固定钢板，矫形满意

表5 2组漏斗胸患儿术后满意度比较[例数(%)]

组别	例数	满意	比较满意	不满意	满意度
研究组	174	152(87.4)	19(10.9)	3(1.7)	171(98.3)
对照组	37	31(83.8)	3(8.1)	3(8.1)	34(91.9)
χ²值		—	—	—	4.501
P值		—	—	—	0.034

表5 2组漏斗胸患儿术后满意度比较[例数(%)]

组别	例数	满意	比较满意	不满意	满意度
研究组	174	152(87.4)	19(10.9)	3(1.7)	171(98.3)
对照组	37	31(83.8)	3(8.1)	3(8.1)	34(91.9)
χ²值		—	—	—	4.501
P值		—	—	—	0.034

[1]	Westphal FL, Lima LC, Lima Neto JC, et al. Prevalence of pectus carinatum and pectus excavatum in students in the city of Manaus, Brazil[J]. J Bras Pneumol, 2009, 35(3): 221-226. DOI: 10.1590/s1806-37132009000300005.
[2]	Cannaerts E, Shukla A, Hasanhodzic M, et al. FLNA mutations in surviving males presenting with connective tissue findings: two new case reports and review of the literature[J]. BMC Med Genet, 2018, 19(1): 140. DOI: 10.1186/s12881-018-0655-0.
[3]	Park CH, Kim TH, Haam SJ, et al. Rib overgrowth may be a contributing factor for pectus excavatum: evaluation of prepubertal patients younger than 10years old[J]. J Pediatr Surg, 2015, 50(11): 1945-1948. DOI: 10.1016/j.jpedsurg.2015.07.010.
[4]	Abid I, Ewais MM, Marranca J, et al. Pectus excavatum: a review of diagnosis and current treatment options[J]. J Am Osteopath Assoc, 2017, 117(2): 106-113. DOI: 10.7556/jaoa.2017.021.
[5]	Haecker FM, Martinez-Ferro M. Non-surgical treatment for pectus excavatum and carinatum[M]// Chest Wall Deformities and Corrective Procedures. Cham: Springer International Publishing, 2015: 137-160.
[6]	Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum[J]. J Pediatr Sur, 1998, 33(4): 545-552. DOI: 10.1016/s0022-3468(98)90314-1.
[7]	曾骐，张娜，范茂槐，等. Nuss手术与改良Ravitch手术的对比研究[J]. 中华小儿外科杂志，2005, 26(8): 397-400. DOI: 10.3760/cma.j.issn.0253-3006.2005.08.002.
[8]	曾骐，段贤伦，张娜，等. 大年龄组漏斗胸的微创Nuss手术[J]. 中华胸心血管外科杂志，2007，23(3): 193-195. DOI: 10.3760/cma.j.issn.1001-4497.2007.03.019.
[9]	Zou J, Luo C, Liu Z, et al. Cardiac arrest without physical cardiac injury during Nuss repair of pectus excavatum[J]. J Cardiothorac Surg, 2017, 12(1): 61. DOI: 10.1186/s13019-017-0624-2.
[10]	Cartoski MJ, Nuss D, Goretsky MJ, et al. Classification of the dysmorphology of pectus excavatum[J]. J Pediatr Surg, 2006, 41(9): 1573-1581. DOI: 10.1016/j.jpedsurg.2006.05.055.
[11]	Nuss D, Kelly RE Jr. Indications and technique of Nuss procedure for pectus excavatum[J]. Thorac Surg Clin, 2010, 20(4): 583-597. DOI: 10.1016/j.thorsurg.2010.07.002.
[12]	Lomholt JJ, Jacobsen EB, Thastum M, et al. A prospective study on quality of life in youths after pectus excavatum correction[J]. Ann Cardiothorac Surg, 2016, 5(5): 456-465. DOI: 10.21037/acs.2016.08.02.
[13]	洪春巧，李炘，陶麒麟，等. Nuss术治疗小儿漏斗胸的CT指数评估[J]. 中华小儿外科杂志，2010, 31(1): 8-11. DOI: 10.3760/cma.j.issn.0253-3006.2010.01.003.
[14]	Chen C, Li X, Zhang N, et al. Different Nuss procedures and risk management for pectus excavatum after surgery for congenital heart disease[J]. J Pediatr Surg, 2018, 53(10): 1964-1969. DOI: 10.1016/j.jpedsurg.2018.04.006..
[15]	Marculescu CE, Osmon DR. Antibiotic prophylaxis in orthopedic prosthetic surgery[J]. Infect Dis Clin North Am, 2005, 19(4): 931-946. DOI: 10.1016/j.idc.2005.07.002.
[16]	Hebra A, Gauderer MW, Tagge EP, et al. A simple technique for preventing bar displacement with the Nuss repair of pectus excavatum[J]. J Pediatr Surg, 2001, 36(8): 1266-1268. DOI: 10.1053/jpsu.2001.25791.
[17]	Abu-Tair T, Turial S, Hess M, et al. Impact of pectus excavatum on cardiopulmonary function[J]. Ann Thorac Surg, 2018, 105(2): 455-460. DOI: 10.1016/j.athoracsur.2017.09.037.

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