Diagnosis And Mininally Invasive Method For Pectus Excavatum In Children

Pectus excavatum (PE) is a kind of deformation of chest wall, which characterized by the depression of the front chest, like a funnel. It is the most familiar deformation disease of the chest wall, nearly 87%, and with the morbidity of 1/300-1/400. The progress of PE is characterized by the feature of succession. When grows worse, the cupped sternum decreases the capacity of cavity of the chest, impacts pulmonary function, depresses heart and makes it displaced, leads cardiac valve not work well, results in the damages of the cardiac function. Operation is the unique effective method for PE. Through operational correction of the deformation, the cardiacopulmonary function is expected to be improved, the mental stress of patient may be resolved. The style of the operation of PE include of 4 kinds: sternal turnover operation and its modified procedure, Ravitch operation and its modified procedure, Nuss operation (MIRPE), and vacuum bell treatment (NIRPE). All these four methods have their own features and indications, our thesis focuses on the NUSS operational age, the standard of evaluation of postoperation briefly. We compare two methods of different of modified NUSS procedure, and conclude our own opinion.Objective Focuse on the NUSS operation, we state the pathogeny, evaluation, operational indication, the best operational age, the standard of evaluation of postoperation briefly. We also compare two methods of different of modified NUSS procedure, and conclude our own opinion. The two methods are the thoracoscopic NUSS procedure and Non-thoracoscopic NUSS procedure.Methods 18 cases of PE have been checked by X ray film, chest CT scan, cardiogram and ultrasound of heart before the operation. After measuring the depression of the malformation, We synthesize different methods of evaluation included thorax- vertebra distance, Haller index, PE index, measuring water method to appraise the severe of the patients. Then we divide all the patients into two style, symmetrical and dissymme- trical group by the Park classified method. According to the standard operational indication of the NUSS procedure which expatiated by Croitoru 2002, we evaluate all the patients, and make sure all of them have a reason to be done the operation.All the 18 patients were performed by NUSS procedure. Among them there are 8 cases chose the NUSS plus thoracoscope auxiliary (A group); 10 cases chose primary NUSS method without thoracoscope auxiliary (B group),in the latter there are 2 cases were performed the surgery through outside of the pleura. The analysis of the gender, age, PE index, Park classification by statistic method indicated that the two groups are comparable, because there are no significant differences in these aspects. (P>0.05) Then we compared the condition of operation time, ache time, chest tube time, postoperative complication, evaluation of the correction. Then we analysed the data, conclude our outcomes, bring out appropriate suggestions.Results All the patients were performed with surgery successful without any severe complications. The blood lost was controlled under 5ml.The postoperative ache time lasted 4 to 5 days. The operation time is about 50-100min, and mean time is 75min. Metal allery which had been healed after local symptomatic treatment happened in two cases of these operations. there are 8 cases chose the NUSS plus thoracoscope auxiliary (A group); 10 cases chose primary NUSS method without thoracoscope auxiliary (B group), in the latter there are 2 cases were performed the surgery through outside of the pleura. All the patients of the A group had been left a thoracic tube by the hole of the thoracoscope, and removed it 3-5 days ago after operation. Two cases happened slightly pneumothorax, and without special treatment recovered themselves. The patients in the B group did not left ordinary chest tube, if necessary there were cases(8 cases) were left a thinner tube in the chest cavity. Before finishing the operation, the anesthetist has been told to expand the lung to make sure there was no air or fluid left in the pleural cavity, then the operator closed the chest cavity. At the first time, the patients had been taken chest X ray check, except one case had been found slightly pneumothorax which then recovered itself, all the other 7 cases no found complications. One case of metal allery happened in B group which is similar to the case of A group, without any severe damage, and through local symptomatic treatment recovered itself. All the patients undergone follow-up survey 0.5-3years, two groups(18 cases) of patients performed"excellent"except one case fallen under"good".The analysis of the gender, age, PE index, Park classification by statistic method indicated that the two groups are comparable, because there are no significant differences in these aspects. (P>0.05) Then we compared the condition of operation time, ache time, chest tube time, postoperative complication, evaluation of the correction. Then we analysed the data, found that the operation time of B group were significantly less than that of A group, and, on the other hand, the result of the ache time was reverse (P<0.05).Conclusion1) Compared with traditional operation method, NUSS procedure has the character of minimally invasive and stability. So NUSS operation should have wider indication.2) According to the follow-up survey, the results of NUSS procedure correction of PE is good, and the excellent stabilization of the bar lead to excellent outcomes of the treatment of the PE. The feature of minimally invasive, less blooding, simple operating, short time of recovering, and nice effect tells us that it is worth for extending. 3)Non-thoracoscopic NUSS procedure can achieve the same excellent outcome of the thoracoscope auxiliary NUSS method, and it can save operation time ,and shorten ache time. It is worth for extending.The feature of our study1) Avoiding discussing the differences between traditional operation and NUSS method ,which has been mentioned a lot already. We go further on this subject, debate the two modified methods of the NUSS procedure, and conclude useful outcome for the developing of NUSS operation.2) According to the feature of the NUSS procedure, we mention that the operation indication should be different with the traditional methods, and through our own thinking we state a few new opinions in our thesis.