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Objective To summarize the experiences with minimally invasive pectus repair (Nuss procedure) for recurrent and acquired pectus excavatum after open thoracic surgery.Methods From Jun 2004 to Sep 2011,eighteen patients with recurrent or acquired pectus excavatum underwent Nuss procedure,including 12 males and 6 females The age ranged from 3.1to 14.8 years with mean age of (8.8 ±4.0) years.The body weight was 11 to 55kg with mean weight of (30.2 ±14.8 ) kg.Ten cases were recurrent pectus excavatum with previously failed open surgery repair,eight were acquired pectus excavatum after other open thoracic surgery.Sixteen cases had symmetrical and 2 had asymmetrical pectus excavatum.Haller' s index was 5.4 ± 3.4.The operation was performed with thoracoscopic assistance.Results All patients had successful operation with one bar insertion in each patient,one stabilizer was put on right side in seventeen and double stabilizers were put in one case.Therapeutic results evaluation was excellent in 16 cases and good in 2.Percentage of excellent and good was the same with that in our primary Nuss procedure ( P ＞ 0.05 ).Chest drainage duration was 1 to 4 days.One case had bar displacement revision 5 months later.Heart perforation occurred in one on whom a sternotomy and perforation repair were immediately performed.The echocardiography exam shows normal cardiac function after operation,and no nerve system complications were detected.One developed pneumothorax on operative day and one had pleural effusion three days later,both were treated by chest tube drainage.Twelve patients' bars were removed after 24 - 45 months of stagnation period.Anatomic results at bar removal were 10 excellent and 2 good,there were no recurrent cases.Conclusion Nuss procedure is an effective method and has good results on recurrent and acquired pectus excavatum.Safety of patients and complications minimization is always the first to be considered.
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Objective To summarize the experiences of Nuss procedure for complicated pectus excavatum.Methods From August 2006 to July 2011,443 patients with pectus excavatum received Nuss operation.Among them,95 patients with complicated pectus excavatum (CT Haller index ＞ 6) received modified technique of Nuss procedure,including multi-bar technique,oblique placed bar,double arc bar technique; fix with wire ; osteotomies ; auxiliary small incision; thoracoscopy placed by different lateral.Results All operations were successfully accomplished without severe complications.The mean operative time was (90.13 ± 39.12 ) minutes and the mean volume of blood loss was (45.41 ± 19.23 )ml.The mean hospital stay was (7.21 ± 2.87 ) days.All patients have been satisfied with their surgical correction.Therapeutic results evaluation was excellent in 75.8％ of patients,good in 16.8％.Conclusion Multi modified technique of Nuss procedure can lead to a satisfactory outcome for complicated pectus excavatum patients.
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Objective To review our experience in correction of pectus excavatum.by Nuss procedure without thoracoscopic assistance.Methods 412 patients with pectus excavatum were surgically corrected using Nuss technique without thoracoscopic assistance.There were 329 boys and 83 girls with average age of 7 years and 8 months ( range from 2 years and 8 months to 28 yeats and 5 months).The bars were removed after surgery in 102 patients.Results The operation in all patients had been performed successfully without any severe complications The average time of the operation was 40 minutes.The average blood lose during operation was ( 10 ±2) ml.Conclusion Nuss procedure without thoracoscopic assistance is safety and effective.It could be minimize the trauma and shorter operating time.
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Objective To summarize the experience of diagnosis and treatment of pectus excavatum associated with congenital pulmonary disease in children.Methods The data of 91 patients with pectus excavatum associated with congenital pulmonary disease was collected from July 2002 to August 2010 in Beijing Children's Hospital.There were 64 males and 27 females.30 patients with pectus excavatum associated with congenital pulmonary cyst,congenital cystic adenomatoid malformation,pulmonary sequestration,and some severe cases of congenital lobar emphysema received the Nuss surgery and lobectomy simultaneously.Results 30 cases with pectus excavatum asseeiated with congenital pulmonary disease received simultaneous Nuss procedure and lobectomy.All cases were confirmed by pathology and recovered uneventfully.Conclusion Chest CT scan is an effective way to evaluate pectus excavatum associated with pulmonary diseases.Whether surgery is needed for the pulmonary disease depend on the specific types of disease,age and other various factors.Simultaneous surgery for pectus excavatum and pulmonary disease can lower the risk of the multiple operations,and reduce the financial burden of famihes.
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Objective To summarize the experiences of Nuss procedure with thoracoscope for repairing pectus excavatum.Methods 21 cases of pectus excavatum were treated by Nuss procedure with thoracoscope.In these patients,10 had symmetric pectus excavatum and 11 had asymmetric one.Results The operation in all patients were successful.The mean operating time wag(70.7±9.6)min and the mean intraoperative blood loss was(20.3±10.9)ml.The average hospital length of stay was(5.3±1.1)days,the average durante dolors was(6.9±4.0)days.The exceUent rate was 81.0%(17/21),including 90.0%(9/10)in symmetric pectus excavatum and 72.7%(8/11)in asymmetric pectus cxcavatum.Conclusion Nuss procedure is easy to perform,with minimal invasion,short operating time,and less blood loss.Nuss procedure is suitable for the symmetric pectus excavatum.