ABSTRACT
Objective Based on the disadvantages of NUSS procedure, we design a new type of funnel chest orthodontic steel bars for clinical application to simplify surgery operation , reduce the surgical trauma, improve operation effect, enhance the safety of operation, and relieve the suffering of the patients, etc.Methods From June 2010 to July 2015, 1020 patients used the new type of funnel chest orthodontic metal plates, including 706 cases of males and 314 cases of females, aged 3-40(aver-age age 11.38 ±5.31).Haller index of 3.36 to 15.45(average index 4.97 ±1.58).668 symmetrical funnel chest cases, 281 cases of asymmetry and 71 recurrent funnel chest cases are involved.Surgical steel bars, having 15 specifications, are arc-shaped, the lengths of which are from 12cm to 26cm.The two ends of steel bars have fixed piece, one end of the bar was fused with a stabilizer and the other end connected to an introducer or a stabilizer and use screws to fix two ends .Steel plates, as the design product, are finalized in the factory.Therefore we need not make intraoperative reprocess.Front tip of introducer and the back-end can be connected to the metal plate.Patients were placed supine position under general anesthesia.Two inci-sions, with length about 2cm and deep to the rib periosteum were made along axillary midline line on the both sides .In the di-rection of high blunt slightly medial free for subcutaneous tunnel to the highest point .Fixed wires were worn around the ribs on both sides.A thoracoscope to guide the bar was inserted from the highest point on the right side of the rear of the medial by sternum low into the chest from the left corresponds to the highest point of the medial , remove the introducer to connect another stator, use screws to fix the connection, with a fixed stator and steel plate stabilized.At the end of the surgery, the stabilizer on either side was secured with sutures.Results The median first operation time was 23 -45(32.31 ±3.57)min, second op-eration time was about 34-147(68.27 ±30.25)min..The bleeding volume(first operation) was 0-2(0.40 ±0.36)ml, the bleeding of second operation time was 1-630(144.00 ±57.00)ml.The hospital stay was 3-9(4.22 ±0.61)days after the operation.All the cases were followed up for 34-48(34.4 ±6.1)months.Steel plate was fixed at the bottom of the sternum in 957 of them,with slight shifting in 58 patients.There was another 5 cases who need re-operation because of the obvious shift-ing.Conclusion The new type of funnel chest orthodontic steel bars simplify surgery operation, reduce the surgical trauma, improve operation effect, relieve the suffering of the patients and enhance the safety of operation.
ABSTRACT
Objective To summarize the preliminary experience of surgical treatment of recurrent pectus excavatum. Methods A total of 23 cases of recurrent pectus excavatum treated in our hospital from January 2012 to December 2014 were reviewed retrospectively. Of the 23 cases, the Nuss method was employed in 15 cases, the modified Nuss method in 6 cases, the Nuss operation and osteotomy in 1 case, and the Ravitch operation in 1 case. Results The surgery was successfully completed in all the 23 patients, without serious complications. The intraoperative blood loss was 10-150 ml (median, 20 ml). The postoperative hospital stay was 4-15 days (mean, 7. 1 days). After operation, 2 cases had more drainage, which were given active thoracic drainage and nutrition. The 23 patients were given removal of steel plate at 2 years after operation, and no recurrence was seen. Conclusions The Nuss operation can be used as the first choice for patients with pectus excavatum repair failure. For patients with recurrence of severe deformity of pectus excavatum, the first choice should be the Ravitch operation.