负压吸盘无创治疗复发性和获得性漏斗胸疗效分析

Noninvasive treatment of recurrent and acquired pectus excavatum with vacuum disk

目的评估负压吸盘无创治疗获得性和复发性漏斗胸临床疗效。方法分析2017年6月至2019年6月浙江大学医学院附属儿童医院心胸外科门诊治疗、符合纳入标准的29例获得性和复发性漏斗胸患儿资料。通过负压吸盘在患儿凹陷胸壁产生负压将胸骨抬高,每天应用时间不低于2 h。应用三维扫描仪(3D扫描仪)扫描患儿胸壁,再通过Geomagic软件处理图像,计算治疗前、后胸骨凹陷深度(3D-DE)及Haller指数(3D-HI),评估负压吸盘治疗获得性和复发性漏斗胸治疗效果。每3个月定期随诊,按负压吸盘使用时间分为3组(组1:≤6个月;组2:6~12个月;组3:>12个月)。结果29例患儿中,对称型漏斗胸18例,非对称型11例,应用负压吸盘3~15个月(平均7.6个月)。目前4例恢复正常,2例无改善,其他凹陷胸骨不同程度改善。患儿3D-DE从17.7 mm下降到11.6 mm,3D-HI从1.739下降到1.598。对称型漏斗胸与非对称型漏斗胸3D-DE及3D-HI改善情况差异无统计学意义(t=-2.821,P=0.558;t=0.074,P=0.068)。组2较组13D-DE及3D-HI改善情况差异有统计学意义(t=-2.261,P=0.014;t=-0.436,P=0.043),组3较组23D-DE及3D-HI改善情况差异无统计学意义(t=-1.240,P=0.139;t=0.622,P=0.568)。患儿出现皮肤红肿(84%)、点状出血(27%)、胸部疼痛(32%)、胸闷不适(17%),目前未出现其他并发症。结论负压吸盘治疗获得性和复发性漏斗胸患儿安全、无创伤,初步效果显著;为治疗获得性和复发性漏斗胸患儿提供更多选择,但远期效果仍需进一步研究。

Objective To evaluate the effect of vacuum disk(VD)for non-invasive treatment of recurrent and acquired pectus excavatum(PE).Methods From June 2017 to June 2019,29 patients recruited from our outpatient clinic were included in this retrospective study and followed-up every 3 month according to the schedule.The patients were distributed into three groups(group 1 treated≤6 months;group 2 treated from 6 months to 12 months;group 3 treated>12 months).The device should be applied regularly for more than 2 hours daily.The deformity chest wall was scanned by three-dimensional(3D)scanner at clinic,and the 3D-depth(3D-DE)and 3D-Haller index(3D-HI)of PE were calculated through Geomagic software.Results In this cohort,29 patients were eligible,18 symmetrical PE and 11 asymmetric PE.The application time ranged from 3 months to 15 months(average 7.6 months).4 paitents was lifted to a normal level,23 patients were differently improved.However,2 paitents had no improvement.The average of the depth and 3D-HI of all patients were improved from 17.7 mm to 11.6 mm and 1.739 to 1.598,respectively.It’s no statistically significant difference for the elevation of 3D-DE and 3D-HI between symmetrical and asymmetric PE(t=-2.821,P=0.558;t=0.074,P=0.068).When comparing the improvement of 3D-DE or 3D-HI of PE to the patient's treatment time,a statistically significant difference was proved between the group 2 and group 1(t=-2.261,P=0.014;t=-0.436,P=0.043),but not between the group 3 and group 2(t=-1.240,P=0.139;t=0.622,P=0.568).The main side effects include moderate subcutaneous hematoma(84%),petechial bleeding(27%),thoracalgia(32%)and chest tightness(17%),no other side effect appear till now.Conclusion VD for treatment of recurrent and acquired PE is convenient,safe and noninvasive,which can be an alternative treatment for recurrent and acquired PE,However,long term of efficacy evaluation is still needed.