Individualized Strategy Selection For Operative Treatment Of Pectus Excavatum In Older Children

Objective:To summarize the surgical experience of thoracoscopic Nuss procedure and intraoperative anti-Nuss procedure for older children with pectus excavatum,discuss the influence of the number of intraoperative plates in Nuss on different types of children with pectus excavatum in older children,and explore the selection of individualized intraoperative treatment strategies for older children,so as to provide certain reference for subsequent surgical treatment.Methods:Retrospective analysis was performed on the data of patients who received thoracoscopic Nuss procedure in Qilu Hospital of Shandong University from January 1,2012 to October 31,2022,to summarize the operative effects of thoracoscopic Nuss procedure.T The collected case data were divided into symmetrical pectus excavatum with single plate group(group A1),symmetrical pectus excavatum with multiple plates group(group B1),asymmetrical pectus excavatum with single plate group(group A2)and asymmetrical pectus excavatum with multiple plates group(group B2)according to the number of plates and Park classification.The effects of different number of plates on the surgical effects,complications and postoperative hospital stay of patients with different types were compared.Results:All 112 cases were successfully completed,including 57 cases in group Al,17 cases in group A2,21 cases in group B1 and 20 cases in group B2.There were no perioperative deaths.Among them,3 children in the A2 group underwent anti-Nuss surgery due to excessive costal arch extraneity.1.The operation time of group B1 was 110 min(82.5,142.5)min,which was longer than that of group A1 that was 90(75,110)min(P<0.01),but the excellent rate of group B1(95.2%)was higher than that of group A1(70.4%)(P<0.05).There was no significant difference in intraoperative blood loss,postoperative hospital stays,postoperative pain score and postoperative complication rate between the two group.2.Compared with the operation time of group A2 which was 85(75,112.5)min,that of group B2 which was 112.5(100,145)min was longer,but the excellent rate of group B2 was higher than that of group A2(95.0%vs 64.7%,P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups,but there were 2 cases of plate displacement in group A2 and no plate displacement in group B2.3.Compared with group A1,there was no significant difference in postoperative indicators including operation time,postoperative efficacy and postoperative complication rate in group Al.The postoperative hospital stay in group B2 was shorter than that in group B1(7±2.471 days vs 9±3.479 days,P<0.05),and there was no significant difference in other indicators.Conclusions:1.The surgical treatment of pectus excavatum needs to choose methods individually.The multiple plates procedure is safe and effective,which is more suitable for elder patients with pectus excavatum,especially patients with asymmetric pectus excavatum.2.The shape of the steel plate should be shaped according to the thorax in patients with asymmetric pectus excavatum3.The anti-Nuss operation could be used for children with excessive convex rib arch in the procedure of Nuss.