Psychological Distress in Patients with Pectus Excavatum as an Indication for Therapy

Background: Adolescents with pectus excavatum (PE) are often affected by their body shape. The aim of our approach was to quantify the patients’ individual psychological distress and to create a psychological indication for treatment. Methods: 10 adolescents (8 male, median age 16 years, interquartile range 15 - 17 yrs.) with PE were examined at our psychological department. Using standardized psychological tests, projective tests and interviews psychologists validated the patients’ individual psychological status. All patients were offered psychological therapy and correction of the deformity. In addition, the children were followed-up by a telephone questionnaire (median follow-up after starting therapy 12.8 months (5.9 - 18.0). Results: No patient had a relevant physiological limitation. The median follow-up since presentation to our psychologists was 15.0 months (9.1 - 20.6). 8 patients (5 were operated, 2 used the vacuum bell, 1 will undergo surgery) had distinct psychological limitations especially concerning the dimensions attractiveness, self-esteem and somatisation. They demonstrated increased insecurity, anxiety and denegation of their body. Since all patients were within puberty the psychological distress due to the PE has to be interpreted as disadvantageous for their further development. 7 patients completed the follow-up questionnaire and reached a median score of 80.8% (76.4% - 86.8%), which indicates a good improvement in all patients. Conclusions: We conclude that the psychological indication for treatment is justified, since our results support this indication.

The application of CT scan in Nuss procedure for pectus excavatum

Objective To study the application CT scans in Nuss procedure for pectus excavatum. Methods 648 children with pectus excavatum underwent Nuss procedure from July 2002 to September 2008. The preoperative CT scan was carried out for evaluation of the deformity degree and morphology classification of chest wall malformation,

Nuss procedure for the correction of pectus excavatum by using double braces in adolescence

Objective To investigate the indication,feasibility and technique of minimally invasive Nuss procedure with thoracoscope by using double braces in the treatment of wide-scope pectus excavatum repairing in adolescence. Methods 31 patients including 24 boys and 7 girls,suffered from pectus excavtum were corrected by Nuss procedure under thoracoscope. The average age

Advances in the management of pectus deformities in children

Pectus excavatum (PE) and pectus carinatum (PC) are relatively common deformities involving the anterior chest wall, occurring in 1:1000 and 1:1500 live births, respectively. While the etiology remains an enigma, the association of pectus deformities with other skeletal abnormalities suggests that connective tissue disease may play a role in their pathogenesis. Clinical features of these deformities vary with severity, as determined by the Haller index and Backer ratio, but frequently include cardiac and respiratory abnormalities. Importantly, there exist profound psychosocial implications for children afflicted with these defofrmities, including but not limited to feelings of embarrassment and maladaptive social behaviors. These debilitating characteristics have prompted the development of novel medical and surgical corrective techniques. The correction of pectus deformities reduces the incidence of physiological complications secondary to chest wall malformation, while simultaneously improving body image and psychosocial development in the affected pediatric population. The Ravitch (open) and Nuss (minimally invasive) procedures remain the most frequently employed methods of pectus deformity repair, with no difference in overall complication rates, though individual complication rates vary with treatment. The Nuss procedure is associated with a higher rate of recurrence due to bar migration, hemothorax, and pneumothorax. Postoperative pain management is markedly more difficult in patients who have undergone Nuss repair. Patients undergoing the Ravitch procedure require less postoperative analgesia, but have longer operation times and a larger surgical scar. The cosmetic results of the Nuss procedure and its minimally invasive nature make it preferable to the Ravitch repair. Newer treatment modalities, including the vacuum bell, magnetic mini-mover procedure (3MP), and dynamic compression bracing (DCB) appear promising, and may ultimately provide effective methods of noninvasive repair. However, these modalities suffer from a lack of extensive published evidence, and the limited number of studies currently published fail to adequately define their long-term effectiveness.

针灸联合自控镇痛泵治疗漏斗胸术后疼痛的效果观察

目的 探讨针灸联合自控镇痛泵(PCAP)治疗漏斗胸患者术后疼痛的疗效。方法 选取2022年1月至2022年12月在广东省第二人民医院胸壁外科行改良Nuss手术治疗的中重度漏斗胸患者作研究对象,共纳入74人,随机分为对照组和观察组。对照组采用自控镇痛泵治疗术后疼痛,观察组在对照组的基础上行双侧神门、内关、合谷、太冲、公孙、阳陵泉穴针灸治疗。采用0~10视觉模拟量表法(VAS)记录并比较两组患者术后疼痛情况,并对两组患者术后下床活动时间,术后不良反应发生情况进行对比。结果 两组患者术后均出现中重度疼痛,经针灸联合镇痛泵治疗96h后,观察组患者VAS评分较对照组下降更快。观察组患者PCAP自控单次给药次数、术后第一次下床活动间隔时间、术后不良反应发生次数均小于对照组(P<0.05)。结论 针灸治疗有助于缓解中重度漏斗胸患者术后疼痛,降低术后不良反应发生的几率,促进漏斗胸患者术后快速康复。

3D打印负压吸盘个体化治疗75例儿童漏斗胸效果

目的:探讨3D打印负压吸盘个体化治疗漏斗胸患儿的治疗效果,并分析3D打印技术在对称型和非对称型漏斗胸治疗中的可行性。方法:回顾性分析2020年3月~2022年4月福州儿童医院收治的通过3D打印负压吸盘个体化治疗的漏斗胸患儿75例的临床资料,包括年龄、性别、Haller指数、漏斗胸深度、横径、纵径以及使用过程中出现的相关不良反应等,通过3D扫描获得使用前后漏斗部各项指标,对使用前后各项指标进行统计学分析,评价其临床治疗效果。结果:根据纳入标准和排除标准共75例患儿被纳入研究,其中男52例(69.33%),女23例(30.67%);年龄平均为(5.57±3.66)岁。75例患者治疗后漏斗部凹陷横径、凹陷纵径、凹陷深度、Haller指数均低于治疗前,差异具有统计学意义(P<0.05);其中44例对称型和31例非对称型漏斗胸患儿治疗后对称型漏斗部凹陷横径、凹陷纵径、凹陷深度、Haller指数也均低于治疗前,差异具有统计学意义(P<0.05)。矫形效果评价中,优秀1例,良好60例,一般14例,优良率高达81.33%。大部分患儿家属对诊疗效果表示满意(89.33%)。干预过程中出现相关不良反应较轻,多无需特殊干预。结论:3D打印负压吸盘个体化在治疗对称型和非对称型漏斗胸患儿均具有良好治疗效果,具有较好的可行性。

疼痛护理干预在小儿漏斗胸Nuss术后的干预效果分析

目的 探究对小儿漏斗胸患儿实施了漏斗胸微创矫正术(Nuss手术)之后采取疼痛护理干预产生的临床效果。方法 简单随机选取六盘水市人民医院于2020年1月—2023年12月接受Nuss手术治疗的40例小儿漏斗胸患儿为研究对象,按照电脑抽签法分为参照组和观察组,每组20例。参照组患儿给予基础疼痛护理,观察组患儿在此基础上优化疼痛护理。对比两组患儿护理后的疼痛评分、哭闹评分、护理满意度。结果 两组患儿在术后1 d的疼痛度评分、哭闹评分对比,差异无统计学意义(P>0.05)。观察组患儿在术后2 d及术后3 d的疼痛度评分、哭闹评分较参照组低,差异有统计学意义(P均<0.05)。护理后,观察组家属的护理满意度(100.00%)较参照组(80.00%)更高,差异有统计学意义(χ^(2)=4.444,P<0.05)。结论 对实施Nuss手术后小儿漏斗胸患儿采取疼痛护理干预具有显著的临床应用价值。

Modified sternal elevation for children with pectus excavatum

Objective To describe our experience in the treatment of pectus excavatum(PE)using a modifed stemal elevation procedure.Methods From Oct.1986 to Dec.1997,171 patients with PE were admitted to the Department of Pediatric Surgery of the First Hospital of West China University of Medical Sciences.All patients were diagnosed through a history and physical examination.Cardiopulmonary function was assessed by M-mode echocardicgraphy and instrument of pulmonary function in 40 patients before and 4.2 years after surgery which was performed between 1989 and 1994.We performed the following three procedures in the stemal elevation:(1)forming the metal strut in a“arch”shape,(2)suturing the perichondrium into a“pipe”shape,and(3)encouraging patients to do chest expansion exercise after operation.All patients were followed up for 1 to 12 years.Results The normal contour of the costal cage was enlarged in all but one patient.Exercise tolerance was improved,and cardiac function recovered to the same level as in healthy children,while pulmonary function recovered very slowly after surgery.Conclusion The normal appearance of chest wall can be recovered and normal cardiopulmonary function can be restored by the modified stemal elevation procedure in children with PE

Pulmonary function changes following surgical correction for pectus excavatum

Objective To assess whether and to what extent pulmonary function returns to normal after surgical correction for pectus excavatum Methods Twenty seven patients who could be examined in person at the outpatient department of our hospital were included in this study Of these patients, 24 were boys and 3 were girls, with age ranging from 3 to 16 years (mean: 8 67 years) The mean age at surgery was 4 years and mean years at follow up was 6 8 Pulmonary function measurements included inspiratory vital capacity (IVC), total lung capacity (TLC), residual volume (RV), functional residual capacity (FRC), RV/TLC ratio, maximal voluntary ventilation (MVV), forced ventilatory capacity (FVC), forced expiratory volume in one second (FEV 1), maximal mid expiratory flow (MMEF), maximal expiratory flow at 75% vital capacity (V 75 ), maximal expiratory flow at 50% vital capacity (V 50 ), maximal expiratory flow at 25% vital capacity (V 25 ) and breathing reserve ratio (BR) Results TLC, FRC, MVV, MMEF, V 75 and V 50 were not different from normal values IVC, FVC, FEV 1 and V 25 were significantly decreased compared with normal values RV and RV/TLC were high in 87 5% cases Conclusions Preoperative symptoms improved substantially after operation Little airway obstruction was observed postoperatively, suggesting that patients with pectus excavatum should have surgery as early in life as possible, preferably by age 3

Radiologic factors related to double-bar insertion in minimal invasive repair of pectus excavatum

Background:Pectus excavatum is the most common congenital chest wall deformity,with a high incidence in live births.This study aimed to evaluate the measured factors on CT images related to the number of pectus bars for surgical correction.Methods:A total of 497 patients who had undergone minimally invasive repair between April 2007 and July 2011 were classified into single-bar(n=358)and double­bar(n=139)insertion groups.We measured eight distinct distances and one angle on CT scans to reflect quantitative assessment.Univariate analysis and multivariate logistic regression analysis were performed to detect statistically significant association between radiologic measurements and the pectus bars required.Results:After adjusting for age and gender,the transverse distance(T),the transverse distance of the depression area(A),the inclined distance of the depression area(B),the AP distance of the depression area(C),the depression angle(G),and the eccentric distance of deformity(E)were significantly correlated with double­-bar insertion.The regression model showed that age(,P<0.0001),gender(P<0.0001),depression angle(G)(P<0.0001),direction of the depression(DD)(P<O.OOO1)and depression depth(D)(P<0.0001)were significantly associated with doublebar insertion.Conclusion:CT scan provides useful factors which can be of assistance in predicting the number of pectus bars for the surgical correction of pectus excavatum.

Changes in electrocardiogram and cardiac function after minimally invasive surgery for pectus excavatum

Background Thoracoscopic minimally invasive pectus excavatum repair （Nuss operation） features its little trauma, simple, short operation time, and good outcome compared with traditional treatment of pectus excavatum surgery-sternal elevation （Ravitch operation） and sternal turnover. The effect of the operation on patients＇ heart and heart function remains unclear. This study aimed to understand the changes of electrocardiogram and cardiac function after Nuss procedure. Methods From 2008 January to 2013 July, thoracoscopic Nuss operation was performed in 217 patients with pectus excavatum. All the patients underwent the preoperative, postoperative detection of ECG and cardiac function in 3 months to 1 year after operation. Results After 3 months to 1 year follow-up, arrhythmias persisted in 46 out of 135 patients with preoperative symptoms （P 〈 0.05）; Stroke volume and cardiac output significantly increased （P 〈 0.05）; And cardiac parameters greatly improved （P 〈 0.05）. Conclusions Minimally invasive repair of pectus excavatum deformity can correct the chest malformation, alleviate arrhythmia, and improve cardiac function.

漏斗胸病儿营养状况及膳食摄入情况调查研究

目的:明确漏斗胸病儿营养状况和膳食摄入情况与漏斗胸严重程度之间的关系,为漏斗胸围术期营养支持和出院后营养指导提供科学依据。方法:收集2022年1月至2023年3月在南京医科大学附属儿童医院心胸外科就诊并在临床营养科进行营养管理的62例漏斗胸病儿的基本资料、实验室检查、影像学检查以及膳食分析情况。结果:62例漏斗胸病儿中存在营养不良39人(62.9%),存在心肺功能受损的病儿有43例(69.4%),心肺功能受损组BMI和BAZ明显低于正常组(P<0.05),两组间身高无明显差异。心肺功能受损组每日能量摄入百分比明显低于正常组(P<0.05),Haller指数明显高于正常组(P<0.05)。相关性分析发现能量摄入百分比与Haller指数负相关(r=-0.314,P=0.032),BAZ值与Haller指数负相关(r=-0.3,P=0.032),BAZ值与能量摄入百分比正相关(r=0.29,P=0.04),差异有统计学意义。结论:大部分就诊的漏斗胸病儿存在能量摄入不足和营养不良,畸形程度越严重对膳食摄入和营养状况的影响越大。

Wang手术治疗12例漏斗胸患儿的体会

目的 总结采用Wang手术治疗漏斗胸的体会。方法 回顾性分析2018年10月至2022年2月郴州市儿童医院收治的12例采用Wang手术治疗漏斗胸患儿的临床资料,其中低龄初治11例,NUSS术后复发1例,所有患儿均采用胸骨下段纵行小切口,于胸大肌起始部向肌肉深层游离至胸廓表面,然后再向两侧做胸廓表面的钢板隧道,剪开剑突及部分胸骨,游离胸骨后与膈肌之间的纤维结缔组织。用钢丝于胸骨下段凹陷处及双侧肋弓行贯穿缝合,置入1块预塑形钢板于隧道,调整居中后,提起钢丝将凹陷抬高并固定于钢板中部。结果 所有患儿均以1块矫形板及3根固定钢丝完成Wang手术,手术时间(43±5.7) min,术中出血(7±1.8) m L,住院天数(8±1.4) d。术后患儿恢复良好,无明显其他并发症。术前Haller指数4.49±0.94,术后Haller指数2.57±0.22,差异均有统计学意义(P<0.05)。根据漏斗胸术后评分标准:9分者8例,8分者4例,效果评价均为非常满意。术后随访期间未出现并发症。结论 相对于NUSS手术,Wang手术无论在手术年龄选择、切口、术后恢复及并发症等方面均优势明显,是一种可以考虑的手术方式。

NUSS术与超微创漏斗胸矫治手术治疗儿童及青少年漏斗胸的疗效比较

目的 比较NUSS术与超微创漏斗胸矫治手术治疗儿童及青少年漏斗胸的效果。方法 回顾性分析130例漏斗胸患者的临床资料,按照手术方式不同分为NUSS术组(80例)和超微创组(50例),NUSS术组实施胸腔镜下NUSS术,超微创组实施超微创漏斗胸矫治手术。比较2组患者手术指标(手术时间、手术切口、住院时间)、Haller指数、疗效及并发症发生率(钢板支架移位率、需要再次手术矫治率、切口感染发生率)。结果 2组患者手术时间及住院时间比较,差异无统计学意义(P<0.05),NUSS术组患者的手术切口小于超微创组(P<0.05);2组患者术后Haller指数较术前低(P<0.05),且NUSS术组患者术后Haller指数较超微创组低(P<0.05);术后6个月,NUSS术组总有效率较超微创组高(P<0.05);NUSS术组并发症发生率较超微创组低(P<0.05)。结论 NUSS术相比超微创漏斗胸矫治术具有手术切口小、创伤小、胸廓形态改善更佳、术后并发症更少的优点。

小儿漏斗胸的外科治疗

漏斗胸是最常见先天性胸壁畸形，可引起患儿呼吸循环功能损害及严重的心理创伤，产生一系列并发症。采用胸骨翻转术和胸骨上举术治疗漏斗胸，各有其不同特点及手术适应证。掌握正确的手术技术，并坚持术后疗法，可纠正胸壁的凹陷畸形，改善患儿运动耐受量及心功能，达到有效治疗目的。

非胸腔镜辅助微创Nuss手术矫治复发漏斗胸

目的探讨非胸腔镜辅助微创Nuss手术治疗复发漏斗胸的有效性和治疗经验。方法2003年7月-2007年11月,手术治疗21例复发漏斗胸患者。其中15例行非胸腔镜辅助微创Nuss术(复发Nuss组),男13例,女2例;年龄(13.31±4.21)岁;CT示胸廓指数3.98±0.94;初次手术后凹陷复发时间<1年2例,1～3年4例,3～5年7例,>5年2例。6例行改良Ravitch术(复发Ravitch组),男5例,女1例;年龄(13.67±2.23)岁;胸廓指数3.92±1.01;初次手术后凹陷复发时间<1年2例,1～3年1例,3～5年3例。另有同期初次行非胸腔镜辅助微创Nuss术治疗119例漏斗胸患者(初次Nuss组),男95例,女24例;年龄(7.79±3.59)岁;胸廓指数4.61±1.36。复发Nuss组、复发Ravitch组年龄及胸廓指数与初次Nuss组比较,差异有统计学意义(P<0.05);复发Nuss组及复发Ravitch组比较,差异无统计学意义(P>0.05)。结果3组患者均顺利完成手术,术中无死亡、大出血及胸腔脏器损伤等严重并发症发生。初次Nuss组及复发Nuss组手术时间、术中出血量及术后入院时间与复发Ravitvh组比较,差异有统计学意义(P<0.05);初次Nuss组与复发Nuss组比较,差异无统计学意义(P>0.05)。术后患者均获随访,随访时间1个半月～37个月,平均11.2个月。除初次Nuss组1例发生钢板移位及2例出现缝线反应再次入院治疗外,其余患者均恢复良好,胸廓无矫形度丢失,运动耐力提高,气短、易疲劳症状改善,抑郁、孤独感减轻或消失。检查示复发Nuss组、复发Ravitch组及初次Nuss组术后胸廓指数分别为2.58±0.31、2.77±0.48及2.52±0.34,与术前比较,3组差异均有统计学意义(P<0.05)。结论复发漏斗胸再次手术矫正虽较初次手术更困难,但只要掌握手术原则、技巧,仔细操作,非胸腔镜辅助下行Nuss手术二次矫正仍然是安全有效的。

婴幼儿与3岁以上儿童漏斗胸术前术后心功能的对比研究

目的探讨不同年龄漏斗胸术前术后的心功能变化。方法对28例婴幼儿、25例3岁以上漏斗胸患儿用超声心动图检测术前及术后12个月的心功能;并选择年龄、性别、身高、体重与患儿匹配的正常儿童作对照。结果婴幼儿漏斗胸心功能的指标SV、EF降低,术后1年复查已恢复到正常水平;而3岁以上病例组SV、EF、MVCF、IVRT明显降低,E/A明显升高,术后与术前比较有明显改善,术后1年随访,除EF、MVCF未恢复外,余指标已无显著性差异(P>0.05)。结论漏斗胸患儿心功能术前均有损害,术后心功能明显改善,并且手术年龄越小,心功能恢复越快。这可为临床选择恰当的手术时机矫治漏斗胸提供参考依据。

微创Nuss手术矫治不同年龄段先天性漏斗胸的临床效果

目的:总结微创Nuss手术矫治不同年龄段先天性漏斗胸的矫形效果,为临床手术时机的选择提供依据。方法:选择3～、6～、≥12岁漏斗胸患儿各20例,均行微创Nuss手术矫治,从围术期情况、术后并发症、术后矫形效果等方面进行比较。结果:不同年龄段漏斗胸患儿的手术时间、出血量、术后住院时间差别不大,差异无统计学意义;而术后使用镇痛药时间、下地活动时间随着年龄的增大而延长,差异有统计学意义;3组均无严重致命性并发症发生,术后并发症的发生率不同年龄段之间无明显差异,且预后良好。术后矫形效果除≥12岁病例组有1例中等外,其余均为优良,且年龄越大术后矫形效果优的比例越少;随着年龄的增大,出现心理障碍的比例明显增加。结论:微创Nuss手术矫治不同年龄段漏斗胸均能取得较好的效果,但年龄越大矫形效果下降,心理障碍的发生率愈高,提示3～岁是微创Nuss手术最适宜的手术年龄。

微创漏斗胸矫形术治疗漏斗胸53例报告

目的探讨微创漏斗胸矫形术（minimally invasive repair of pectus excavatum或Nuss手术）的近期效果。方法53例均在气管插管全麻下手术。双侧胸壁做横行切口，在胸腔镜下将塑形之矫形板由右胸腔经胸骨后穿至左胸腔，翻转矫形板，将胸骨抬起矫正胸骨凹陷，矫形板两侧用固定片固定于肋骨。矫形板放置2年后取出。结果53例均顺利完成手术，手术时间30-240min，平均47min，无术中并发症。术后住院2～14d，平均6．1d。术后疼痛超过1周1例；气胸7例；皮下气肿11例；矫形板旋转3例；单侧固定片滑脱4例；切口感染3例，其中2例被迫将矫形板取出，1例经清创换药伤口愈合。53例随访3-28个月，平均15．6月，优42例，良4例，一般3例，差4例。结论Nuss手术治疗小儿漏斗胸近期效果满意。

胸腔镜下Nuss手术治疗小儿漏斗胸38例报告

目的探讨胸腔镜下Nuss手术治疗小儿漏斗胸的疗效和安全性。方法胸腔镜监视下用穿通器在胸骨凹陷最低点水平，两腋中线之间，于胸膜外经胸骨后穿通一遂道，放置支撑板将凹陷胸骨抬起，支撑板两端安装固定器。5例使用进口器械，33例使用国产器械。结果38例均在胸腔镜辅助下顺利完成手术，手术时间40～80min，平均50min。术中出血量5～30ml，平均16ml。36例放置1根钢板支撑，2例放置2根钢板支撑。术后气胸4例，皮下气肿16例，右侧固定器滑脱1例，钢板轻度翻转1例。术后住院7～21d，平均8d。38例随访3～22个月，平均11个月，优36例，良2例，优良率100％。结论胸腔镜辅助下Nuss手术治疗小儿漏斗胸方法安全可靠，疗效好，手术最佳时机3～12岁。