| Objective:To investigate the feasibility,safety and therapeutic effect of minimally invasive sternal lifting procedure and vacuum bell in the treatment of pectus excavatum in preschool children compared with the Nuss procedure,and summarized the clinical experience in order to provide reference for the individualized diagnosis and treatment of preschool children with pectus excavatum.Methods:The clinical data of 88 preschool children(defined as under 6 years old)who were diagnosed with pectus excavatum and received corrective treatment in the Department of Thoracic Surgery,Lanzhou University Second Hospital from January2017 to December 2021 were retrospectively analyzed.According to different treatment methods,they were divided into the minimally invasive sternal lifting surgery group(18 cases),the Nuss procedure group(42 cases)and the vacuum bell technique group(28 cases).The differences of general data,medical history characteristics,clinical symptoms and complications among the three groups were compared and analyzed.The perioperative data,postoperative complications,and postoperative therapeutic effects of the minimally invasive sternal lifting group and the Nuss procedure group were analyzed.The vacuum bell group were treated with 3D scanning technology to obtain the surface image of the patient and customize the vacuum bell individually,with outpatient review every 3 months to record pre-and post-treatment clinical photographs,3D scanning images,and to understand patient compliance and complications.The depression depth and depression depth ratio of pectus excavatum before and after treatment were measured on the scanning images.The therapeutic effect was evaluated and the factors affecting the therapeutic effect of vacuum bell were analyzed.Result:1.There was no significant difference in gender,morphological typing,clinical symptoms and complications between the three groups(p>0.05).The vacuum bell group was younger than the minimally invasive sternal lifting group and the Nuss procedure group(p<0.05).Compared with the Nuss procedure group,the minimally invasive sternal lifting group were younger(3.73±1.06 years vs.4.66±0.92 years,p<0.05),haller index was smaller[3.55(0.9)vs.4.15(1),p<0.05].2.Perioperative data were compared between the minimally invasive sternal lifting group and the Nuss procedure group.The operation time of the minimally invasive sternal lifting group was significantly shorter[65(17.5)vs.109(30),p<0.001].The intraoperative blood loss was less[5(5)vs.20(10),p<0.001].The postoperative hospital stay was shorter[3.5(2)vs.5(3),p<0.001].The overall complication rate for both groups was not statistically significant(p>0.05),but the specific types of complications were different.The wound infection rate was 16.6%(3/18)in the minimally invasive sternal lifting group,and pneumothorax and pleural effusion were more common in the Nuss procedure group.The vacuum bell group,the funnel depth was(12.0±4.0)mm before treatment and(7.2±3.2)mm after treatment,and the difference was statistically significant(t=9.781,p<0.001);The infundibulation depth ratio was 0.16±0.04 before treatment and 0.11±0.04 after treatment,and the difference was statistically significant(t=11.652,p<0.001).The vacuum bell group,all patients had mild skin erythema,5cases(17.8%)of skin petechiae,12 cases(42.8%)of pain,and no other complications.3.According to Nuss procedure evaluation criteria,the results of the minimally invasive sternal lifting group were excellent in 10 cases(55.5%),good in 6 cases(33.3%),fair in 1 case(5.6%),and poor in 1 case(5.6%),with an excellent and good rate of 88.9%.In the Nuss procedure group,the results were excellent in 27 cases(64.3%),good in 9 cases(21.4%),fair in 6 cases(14.3%),and poor in 0 case(0%),with an excellent and good rate of 85.7%.There was no significant difference in efficacy between the minimally invasive sternal lifting group and the Nuss procedure group(Z=-0.503,p=0.615).According to Obermeyer’s efficacy evaluation criteria,the results were excellent in 8 cases(28.6%),good in 7 cases(25%),fair in 8 cases(28.6%),and poor in 5 cases(17.8%)in the vacuum bell technique group,with an excellent and good rate of 53.6%.Simplified grouping according to efficacy(excellent/good group,moderate/poor group)showed that patients with smaller initial depression depth,smaller initial depth ratio and longer treatment duration had better treatment outcomes.In addition,linear regression analysis showed that there was a significant correlation between the length of treatment time and the change of depth ratio(R~2=0.391,p<0.001).Conclusions:The efficacy and safety of minimally invasive sternal lifting procedure are similar to that of the Nuss procedure in the treatment of pectus excavatum in preschool children,but the sternal lifting procedure is more minimally invasive,simpler to operate,less postoperative pain and better cosmetic effect.For preschool children with small age,mild deformity and good flexibility of chest wall,3D printing customized vacuum bell are safe and feasible.Even if the treatment of vacuum bell fails,the children still have the opportunity to choose surgical treatment. |
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