| Objective:To explore the efficacy and technical characteristics of the Wang procedure by retrospectively analyzing the perioperative indicators of the Wang procedure in the treatment of low-age pectus excavatum patients,aiming to provide new programs and new ideas for the surgical treatment of low-age pectus excavatum.Method:The clinical data of pectus excavatum patients who received thoracic deformity correction surgery at the Department of Chest Wall Surgery,Guangdong Second Provincial General Hospital from January 01,2018 to December 31,2020 was reviewed.According to the different surgical methods,the patients were divided into the Wang procedure group and the modified Nuss procedure group.According to the inclusion and exclusion criterias,a total of 125 patients and 215 patients were enrolled in the Wang procedure group and the modified Nuss procedure group,respectively.The medical history and treatment information of the patients was collected on five aspects:general information,medical history characteristics,imaging examination,perioperative surgical treatment related indicators,and postoperative follow-up.The data was collected including gender,age,clinical symptoms,types and cases of special diseases in the past medical history,symmetry of pectus excavatum,type and cases of abnormal signs during physical examination,abnormal results of electrocardiogram examination,Haller index before and after surgery measured by chest X-ray or CT.The severity of pectus excavatum was described as mild,moderate and severe accounting to the preoperative Haller index.The data of surgery time,intraoperative blood loss,length of postoperative hospital stay,postoperative curative efficacy score,postoperative complications types and cases,and follow-up results were recorded at the same time.The data collected in the Wang procedure group was summarized and statistically analyzed,and the corresponding indicators were compared with those in the modified Nuss procedure group to discuss the efficacy and technical characteristics of the Wang procedure in the treatment of low-age pectus excavatum.Results:A total of 125 children were enrolled in the Wang procedure group,including 98 males and 27 females,aged from 10 months old to 6 years old,with an average age of(3.74±2.04)years old.There were 28 cases with clinical symptoms,and 3 patients were unsatisfied with the treatment effect after Nuss procedure performed in other departments.7 patients had surgical history of other chest diseases before,including 1 case of congenital cystadenoma resection,1 case of foramen ovale suture closure,3 cases of ventricular septal defect repair,1 case of correction of tetralogy of Fallot,and 1 case of unknown procedure).2 cases of asymmetric pectus excavatum and 20 cases of heart murmur,heart shifts,abnormal breath sounds and scoliosis in total were found on physical examination.18 cases had abnormal electrocardiogram results.39 cases,16 cases and 70 cases of mild,moderate and severe pectus excavatum were diagnosed respectively,with an average Haller index of(4.35±1.82).A total of 215 patients were enrolled in the modified Nuss procedure group,including 184 males and 31 females,aged from 9 to 50 years old,with an average age of(17.59±6.95)years old.96 cases were accompanied by clinical symptoms.5 cases of asymmetric pectus excavatum,15 cases with flat chest and 27 cases of heart murmur,heart shifts,abnormal breath sounds and scoliosis in total were found on physical examination.52 cases with abnormal electrocardiogram results.56 cases,34 cases and 125 cases of mild,moderate and severe pectus excavatum were diagnosed respectively,with an average Haller index of(4.18±1.75).Surgeries were successfully performed in all patients.In the Wang procedure group and the modified Nuss procedure group,the average surgery time were(24.61±5.41)min VS(50.75±15.70)min,P<0.001.The average intraoperative blood loss was(2.22±1.75)mL VS(7.36±4.71)mL,P<0.001.The average length of postoperative hospital stay were(5.33±1.40)d VS(7.33±3.23)d,P<0.001.The average Haller index before and after surgery in the Wang procedure group was(4.35±1.82)VS(2.69±0.45),P<0.001.The average curative effect score was(8.73±0.63)in the Wang procedure group,which reached a satisfactory standard.The total postoperative complications rate in the Wang procedure group was 8.80%,lower than that of 11.63%in the modified Nuss procedure group.Conclusion:Compared with the modified Nuss procedure in the treatment of young pectus excavatum,the Wang procedure has similar effects and less incision,shorter operation time,less intraoperative blood loss,shorter length of the postoperative hospital stay time,and lower postoperative complications rate in the treatment of low-age pectus excavatum patients.From this study,it can be seen that for low age pectus excavatum patients,especially for those with secondary deformities after failure of Nuss procedure and those with pectus excavatum after cardiac surgery,Wang procedure is an ideal choice.But considering the short follow-up time in this study,the long time efficacy of the Wang procedure still needs to be observed. |
PDF Full Text Request