DU Jie,HU Xingti,ZHAO Qifeng, et al. Application of the modified Nuss procedure for pectus excavatum repair with bilateral chest wall vertical incisions in 240 patients[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2014, 44(11): 797-.
Abstract：Objective: To explore the surgical skills and efficacy of the modified Nuss procedure on pectus excavatum repair with bilateral chest wall vertical incisions. Methods: Two hundred forty patients (181 male, 59 female, aged 2.5-25 years with an average of 8.0 ±5.1 years) with pectus excavatum undergone the modified Nuss procedure in our hospital between August 2006 and April 2014 were recruited in this study. One hundred and sixty-four out of 240 patients were symmetry and 76 were asymmetry according to the Park’s classification. Preoperative Haller Index (HI) of the patients was determined by computed tomography (CT) and ranged from 3.3 to 16.5 with an average of 5.1±1.9. All patients were anesthetized by combined tracheal in intubation and intravenous anesthesia, underwent the modified Nuss procedure assisted by thoracoscopy, and not used of pleural drainage tubes. Results: The surgery of all patients went smoothly, and the operating time ranged from 30 to 90 minutes with an average of (45.56±13.48) minutes. The plates were changed to diagonal placement because of the ineffective repairs of the lateral placement in 15 cases. Sequential biventricular thoracoscopy for bilateral chest wall were applied in 10 cases due to extremely severe pectus excavatum. Severe complications, such as penetrating injuries on heart, lung and diaphragm, didn’t occurred and the amount of bleeding was little (less than 20 ml) during the operation. 20, 6, and 4 patients showed subcutaneous emphysema, little pneumothorax, and pleural effusion after operation, respectively. All complications relieved after conservative therapy. Post-discharge follow-up time was 1-48 months. During the early 3 months follow-up period, 212 of 240 cases (88.3%) showed excellent molding effects while 28 cases (11.7%) attained good molding effects. And no bad corrective results happened. In the middle to late after operation, 10 incision allergic reactions of the plates occurred. The buttress plates of 136 patients were removed during the period of 24-40 months after operation and 6 showed slightly recurrence. Conclusion: The modified Nuss procedure with vertical incisions on bilateral chest walls simplifies the processes of the classical Nuss procedure, and is worth of being generalized.
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