| Objective:By detectingthe pulmonary function indexes of pectus excavatum(PE)patients treated with minimally invasive Nuss procedure before and after the operation and after the Nuss bar removal,to analyze the influence of minimally invasive Nuss procedure on pulmonary function in each stage of postoperation,and to compare the changes of pulmonary function and sungical outcome in different age groups after minimally invasive Nuss procedure.To investigate the relationship between the changes of pulmonary function and age group for provide reference the optimal timing of minimally invasive Nuss procedure on PE patients.Methods:From August 2006 to November 2014,the 676 cases of PE patients were treated with minimally invasive Nuss procedure in department of thoracic surgery in Guangdong General Hospital.There were 182 patients with complete clinical data and pulmonary function index in preoperative and postoperative lyear and 3 years.71 patients had the complete data of pulmonary function after 1 year of Nuss bar removal.(1)182 cases of patients were divided into children group(6-12 years old,n=34),youth group(13-18 years old,n=80)and adult group(>18 years old,n=68).The clinical data of 182 patients were observed.The Pearson correlation analysis between Haller index and age,height and weight,preoperative pulmonary function had been carried out.The correlation between Haller index and age,height and weight,preoperative pulmonary function of the patients were discussed.(2)Haller index as the standard,according to the severity of the PE,each group of patients were divided into moderate group(Haller index<3.5)and severe group(Haller index>3.5).The preoperative pulmonary function indexes(including FVC,FEV1,FEF25%-75%,FEF50%,FEF75%)were compared in moderate group and severe group.(3)The basic data in the three groups were observed including gender,age,BMI,Haller index,PE severity,whethercombined with flat chest,combined with lesion and restrictive degree of pulmonary ventilation dysfunction.The pulmonary function indexes(FVC,FEV1,FEF25%-75%,FEF50%,FEF75%)preoperative and 1 year and 3 years after operative were compared,respectively.(4)71 cases of Nuss bar removal patients with complete data of pulmonary function in 1 year of follow-up were divided into children group(6-12 years old,n=20),youth group(13-18 years old,n=14)and adult group(>18 years old,n=20).The pulmonary function indexes(FVC,FEV1,FEF25%-75%,FEF50%,FEF75%)in preoperative,before Nuss bar removal and 1 year after Nuss bar removal were compared,respectively.Results:(1)A total of 182 PE patients were included in the study,and 151 cases were male,31 cases were female.The average age was(15.9±5.5)years,average height was(163.5±17.1)cm,and average weight was(46.9±12.5)kg.The Haller index was 3.2 to 25,and the average value was(4.5±2.0).The Pearson correlation analysis between Hall index and age,height and weight,preoperative pulmonary functionhad been carried out The results showed that:There was no correlated between Haller index with overall age,and was negatively correlated with weight and height.The Haller index of female was lower than that of male in children group.The Haller index of female was higher than that of male in youth group and adult group.(2)There was no significant difference in preoperative pulmonary function index between moderate groupand severe group in children group,youth group and adult group.(3)There were no significant differencesbetween the pulmonary function indexes of children group in 1 year,3 years and preoperative(P>0.05).The FVC and FEV1 of youth group and adult group in 1 year and 3 years after operation was significant lower than that before operation(P<0.01),but the FEF25-75%,FEF50%and FEF75%were higher than that before operation with different degrees(P<0.05).There were no significant differences in pulmonary function indexes of children group,youth group and adult group between the 3 years after operation and 1 year after operation(P>0.05).(4)In children group,there were no significant differences in the pulmonary function indexesbetween before Nuss bar removal and preoperative(P>0.05),and all the pulmonary function indexes in 1 year after Nuss bar removal were significantly higher than that before operation(P<0.05).In youth group,FVC before bar removal was significantly lower than that before operation(P<0.05).After bar removal,FVC returned to preoperative level,but there were no significant differences in the pulmonary function indexesbetween 1 year after bar removal and before operation(P>0.05).In adult group,FVC before Nuss bar removal was significantly lower than that before operation(P<0.05),and partial small airway function index(FEF50%and FEF75%)were significantly improved(P<0.05).FVC in 1 year after Nuss bar removal returned to preoperative level,but the improvement of small airway function index also returned to preoperative level.The overall lung function was not significantly improved between 1 year after Nuss bar removal and that before operation(P>0.05).Conclusion:(1)The higher the Haller index of the PE patients,the more obvious the lung function damage.There was no correlated between Haller index with overall age,and was negatively correlated with weight and height.(2)After bar insert,chest compliance decreased and airway abstruction was noted in youth groupand adult groups,but the index in lung function for small airway improved.There were no significant changes in the pulmonary function indexes of children group.(3)After 1 year Nuss bar removal,the improvement of lung function was the most obvious in the children group.There were no significant differencesbetween the pulmonary function indexes of youth groupand adult groups in postoperative and preoperative.(4)Pectus excavation surgery in childrenmay be more beneficial to the recovery of lung function.However,further studies are needed to investigate the optimal age of surgery. |
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