| Objective: To summarize the clinical efficacy and related treatment experience of non-thoracoscopic-assisted Nuss procdure in the correction of pectus excavatum,to further improve the effect of pectus excavatum surgery.At the same time,the efficacy and complications of Nuss procdure in different age groups were compared in order to provide some reference for the best operation time of Nuss procdure for pectus excavatum.Methods: A retrospective analysis of 690 cases of Pectus excavatum treated by Nuss procdure at Children’s Hospital Affiliated to Chongqing Medical University between January 1,2006 and December 31,2016 was performed,the clinical experience was summarized in terms of perioperative index,operative effect and complications.All cases were divided into three groups according to age: Group A,age < 6 years(272 cases);Group B,age 6 ～ 12 years(234 cases);and Group C,age ≥12 years(184 cases).And the clinical indexes,surgical efficacy and complications were compared and analyzed.Results: All patients underwent non-thoracoscopic Nuss procedure without any perioperative death.The average operation time was 57.84 ± 17.84 min,and the average intraoperative blood loss was 6.03 ± 7.24 ml.Complications occurred in 121 cases,all of which were postoperative,including pneumothorax in 5 cases,pleural effusion in 9 cases,subcutaneous emphysema in 26 cases,bar displacement in 19 cases,metal allergy in 15 cases,incision infection in 27 cases,atelectasis in 38 cases,and two or more complications in 24 cases,no severe complications such as cardiac perforation,pericardial effusion,massive hemorrhage and diaphragm injury occurred.Up to now,639 cases of steel plate have been removed.After followed up from 1 month to 10.5 years,622 patients(97.34%)had good or excellent orthopedic effect.4 cases reappeared slight depression in the inferior segment of the sternum after operation,and all of them were not reoperated and were regularly followed up.The cases were divided into groups according to age and compared.In terms of symmetry,the number of cases of symmetry in group C was less than that in group A and B,and there was significant difference between group B and group C(P < 0.05).The perioperative index,the length of operation in group A,B and C increased with age,and the difference was statistically significant(P < 0.001).The postoperative hospital stay in group A was lower than that in group B(P < 0.05),and the amount of intraoperative blood loss in group A was lower than that in group C(P < 0.05).It is suggested that the operation time,intraoperative bleeding and postoperative hospital stay tend to increase with age.There was no significant difference in Haller index among the three groups before operation,but the postoperative Haller index in group C was significantly higher than that in group A and B(P < 0.001),and increased with age.There was no significant difference in the total and all kinds of surgical complications among the three groups(P > 0.05),but the incidence of pneumothorax,wound infection and plate allergy in Group A was lower than that in Group B and C,in particular,there was no case of scoliosis.The excellent and good rate of postoperative orthopedic effect in the three groups was 98.44%,96.88% and 96.23% respectively,with no statistical difference(P > 0.05),but with the increase of age,the excellent and good rate of operation decreased.Conclusion: 1)Non-thoracoscopic-assisted Nuss procdure for the treatment of pectus excavatum in children is safe and effective.2)Nuss procdure can achieve good orthopedic results in all age groups,but with the increase of operation age,the rate of excellent and good operation decreased,the operation time prolonged,the intraoperative bleeding increased,and the postoperative recovery was also slower.However,there was no significant difference in the incidence of postoperative complications among different age groups.3)Based on the previous studies on cardiopulmonary function and psychology,combined with the results of this study,we suggest that the optimal age for Nuss procedure should be 3 to 6 years old. |
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