| [Objective]Pectus excavatum(PE)accounts for about 4%of chest wall deformities.Surgical intervention is the main treatment method.According to domestic and international research,funnel chest NUSS orthopedics is safe and feasible.Minimally invasive effects are better promoted and used.Due to the widespread use of NUSS surgery,the evaluation of postoperative effects and the incidence of complications are also hotspots.Many literatures at domestic and foreign indicate that the pulmonary function of patients in the early postoperative period of NUSS decreases,but there are fewer studies in the long term.The purpose of this article is to explore the effects of pulmonary function changes and surgical methods on postoperative recovery and pulmonary function in patients with funnel chest.[Methods]The clinical data of thoracic funnel patients undergoing NUSS surgery in Department of Thoracic Surgery,the First Affiliated Hospital of Kunming Medical University from 2017 to 2019 were collected.All patients were divided into 5 mild cases(10%)in group A,6 moderate cases(12%)in group B,and 39 severe cases(78%)in group C according to Haller Index;they were also divided into unilateral incision groups according to NUSS surgery Thirty patients(60%)and 20 patients(40%)in the bilateral incision group.Preoperative CT scans of the chest,pulmonary function,electrocardiogram,intraoperative time,bleeding,postoperative complications,chest radiographs,and hospital stay were recorded.Observe the correlation between the various indexes of the patients before operation and compare the changes of lung function before and after the operation.Observe and compare the results of the two surgical methods.[Results]All 50 patients successfully completed the operation without fatal complications.The preoperative FVC decreased gradually with the increase of the funnel chest index,but there was no statistical significance(F=2.184,P=0.124).Group A was compared with group B(mean difference was 0.55,P=0.121),and group A and group C Comparison(mean difference 0.57,P=0.043),group B compared with group C(mean difference 0.019,P=0.94),pairwise comparison found that there was statistical significance between group A and group C;preoperative FEV1 also followed The increase of the funnel chest index gradually decreased(F＝3.696,P＝0.032);the preoperative FEV1/FVC gradually decreased with the increase of the funnel chest index(F=3.368,P=0.043).Pulmonary function index changes in each group before and after surgery.Group A,B,and C groups had improved postoperative FVC(P<0.05),FEV1 improved(P<0.05)after operation,and FEV1/FVC Improved compared with preoperative(P<0.05).After unilateral incision NUSS surgery and bilateral incision NUSS surgery,the pulmonary function of patients was improved compared with that before surgery(P<0.05).The operation time of unilateral incision group vs bilateral incision group[(77.40±49.62)VS(90.75±31.32)min,P=0.291];intraoperative bleeding volume vs.bilateral incision group[(11.27±17.77)ml VS(20.75±17.49)ml,P＝0.069];postoperative hospital stay vs.bilateral Side incision group[(6.75 ± 2.26)d vs(8.75 ± 2.87)d,P=0.01].[Conclusion](1)The growth and development of patients with funnel chest are affected,and most patients have malnutrition to varying degrees.(2)The pulmonary function of patients with funnel chest is positively correlated with the severity of the funnel chest.After NUSS,the pulmonary function of patients is improved compared with the previous one.The improvement of patients’ pulmonary function after removing the steel plate still needs further research.(3)Both surgical methods are safe and effective.Unilateral incisions are more advantageous than bilateral incisions,but longer-term efficacy requires longer observation and follow-up,(4)Increasing age has made NUSS surgery more difficult,but NUSS surgery is also safe and feasible. |
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