Objective:To investigate the clinical efficacy and safety of the extrapleural approach versus the traditional intrathoracic approach in minimally invasive correction of pectus excavatum in children,providing a more sc...Objective:To investigate the clinical efficacy and safety of the extrapleural approach versus the traditional intrathoracic approach in minimally invasive correction of pectus excavatum in children,providing a more scientific basis for selecting a more appropriate surgical method in clinical practice.Methods:This study included 50 children who underwent pectus excavatum correction at Harbin Children’s Hospital from January 2023 to January 2025.All patients were divided into two groups based on surgical approach:the observation group(n=26)and the control group(n=24).Children in the observation group underwent correction surgery via an extrapleural approach,while those in the control group underwent correction surgery via the traditional intrathoracic approach.Both groups underwent Nuss bar placement surgery under thoracoscopic guidance.Intraoperative indicators were compared between the two groups,including operative time,blood loss,pain scores at 24 and 48 hours postoperatively,hospital stay duration,thoracic correction outcomes,and the incidence of complications during a 6-month postoperative follow-up.Results:The intraoperative blood loss in the observation group was significantly lower than that in the control group(p<0.05),and the pain scores at 24 and 28 hours postoperatively were also significantly lower(p<0.05).The improvement in thoracic index postoperatively was relatively similar between the two groups,with no statistically significant difference(p>0.05).During the 6-month postoperative follow-up period,no complications such as pneumothorax,hemothorax,pleural effusion,plate displacement,or infection occurred in the observation group,whereas the overall complication rate in the control group was 25%,showing a significant difference(p<0.05).Conclusion:The extrapleural approach for corrective surgery can ensure the efficacy of thoracic deformity correction while reducing intraoperative blood loss,lowering the incidence of complications,alleviating postoperative pain,and accelerating recovery.It is a safe and effective approach for minimally invasive Nuss correction of pediatric pectus excavatum.展开更多
Background: Adolescents with pectus excavatum (PE) are often affected by their body shape. The aim of our approach was to quantify the patients’ individual psychological distress and to create a psychological indicat...Background: Adolescents with pectus excavatum (PE) are often affected by their body shape. The aim of our approach was to quantify the patients’ individual psychological distress and to create a psychological indication for treatment. Methods: 10 adolescents (8 male, median age 16 years, interquartile range 15 - 17 yrs.) with PE were examined at our psychological department. Using standardized psychological tests, projective tests and interviews psychologists validated the patients’ individual psychological status. All patients were offered psychological therapy and correction of the deformity. In addition, the children were followed-up by a telephone questionnaire (median follow-up after starting therapy 12.8 months (5.9 - 18.0). Results: No patient had a relevant physiological limitation. The median follow-up since presentation to our psychologists was 15.0 months (9.1 - 20.6). 8 patients (5 were operated, 2 used the vacuum bell, 1 will undergo surgery) had distinct psychological limitations especially concerning the dimensions attractiveness, self-esteem and somatisation. They demonstrated increased insecurity, anxiety and denegation of their body. Since all patients were within puberty the psychological distress due to the PE has to be interpreted as disadvantageous for their further development. 7 patients completed the follow-up questionnaire and reached a median score of 80.8% (76.4% - 86.8%), which indicates a good improvement in all patients. Conclusions: We conclude that the psychological indication for treatment is justified, since our results support this indication.展开更多
Background Thoracoscopic minimally invasive pectus excavatum repair （Nuss operation） features its little trauma, simple, short operation time, and good outcome compared with traditional treatment of pectus excavatum...Background Thoracoscopic minimally invasive pectus excavatum repair （Nuss operation） features its little trauma, simple, short operation time, and good outcome compared with traditional treatment of pectus excavatum surgery-sternal elevation （Ravitch operation） and sternal turnover. The effect of the operation on patients＇ heart and heart function remains unclear. This study aimed to understand the changes of electrocardiogram and cardiac function after Nuss procedure. Methods From 2008 January to 2013 July, thoracoscopic Nuss operation was performed in 217 patients with pectus excavatum. All the patients underwent the preoperative, postoperative detection of ECG and cardiac function in 3 months to 1 year after operation. Results After 3 months to 1 year follow-up, arrhythmias persisted in 46 out of 135 patients with preoperative symptoms （P 〈 0.05）; Stroke volume and cardiac output significantly increased （P 〈 0.05）; And cardiac parameters greatly improved （P 〈 0.05）. Conclusions Minimally invasive repair of pectus excavatum deformity can correct the chest malformation, alleviate arrhythmia, and improve cardiac function.展开更多
Objective To study the application CT scans in Nuss procedure for pectus excavatum. Methods 648 children with pectus excavatum underwent Nuss procedure from July 2002 to September 2008. The preoperative CT scan was ca...Objective To study the application CT scans in Nuss procedure for pectus excavatum. Methods 648 children with pectus excavatum underwent Nuss procedure from July 2002 to September 2008. The preoperative CT scan was carried out for evaluation of the deformity degree and morphology classification of chest wall malformation,展开更多
Objective To investigate the indication,feasibility and technique of minimally invasive Nuss procedure with thoracoscope by using double braces in the treatment of wide-scope pectus excavatum repairing in adolescence....Objective To investigate the indication,feasibility and technique of minimally invasive Nuss procedure with thoracoscope by using double braces in the treatment of wide-scope pectus excavatum repairing in adolescence. Methods 31 patients including 24 boys and 7 girls,suffered from pectus excavtum were corrected by Nuss procedure under thoracoscope. The average age展开更多
Objective To assess whether and to what extent pulmonary function returns to normal after surgical correction for pectus excavatum Methods Twenty seven patients who could be examined in person at the outpatient de...Objective To assess whether and to what extent pulmonary function returns to normal after surgical correction for pectus excavatum Methods Twenty seven patients who could be examined in person at the outpatient department of our hospital were included in this study Of these patients, 24 were boys and 3 were girls, with age ranging from 3 to 16 years (mean: 8 67 years) The mean age at surgery was 4 years and mean years at follow up was 6 8 Pulmonary function measurements included inspiratory vital capacity (IVC), total lung capacity (TLC), residual volume (RV), functional residual capacity (FRC), RV/TLC ratio, maximal voluntary ventilation (MVV), forced ventilatory capacity (FVC), forced expiratory volume in one second (FEV 1), maximal mid expiratory flow (MMEF), maximal expiratory flow at 75% vital capacity (V 75 ), maximal expiratory flow at 50% vital capacity (V 50 ), maximal expiratory flow at 25% vital capacity (V 25 ) and breathing reserve ratio (BR) Results TLC, FRC, MVV, MMEF, V 75 and V 50 were not different from normal values IVC, FVC, FEV 1 and V 25 were significantly decreased compared with normal values RV and RV/TLC were high in 87 5% cases Conclusions Preoperative symptoms improved substantially after operation Little airway obstruction was observed postoperatively, suggesting that patients with pectus excavatum should have surgery as early in life as possible, preferably by age 3展开更多
Objective To describe our experience in the treatment of pectus excavatum(PE)using a modifed stemal elevation procedure.Methods From Oct.1986 to Dec.1997,171 patients with PE were admitted to the Department of Pediatr...Objective To describe our experience in the treatment of pectus excavatum(PE)using a modifed stemal elevation procedure.Methods From Oct.1986 to Dec.1997,171 patients with PE were admitted to the Department of Pediatric Surgery of the First Hospital of West China University of Medical Sciences.All patients were diagnosed through a history and physical examination.Cardiopulmonary function was assessed by M-mode echocardicgraphy and instrument of pulmonary function in 40 patients before and 4.2 years after surgery which was performed between 1989 and 1994.We performed the following three procedures in the stemal elevation:(1)forming the metal strut in a“arch”shape,(2)suturing the perichondrium into a“pipe”shape,and(3)encouraging patients to do chest expansion exercise after operation.All patients were followed up for 1 to 12 years.Results The normal contour of the costal cage was enlarged in all but one patient.Exercise tolerance was improved,and cardiac function recovered to the same level as in healthy children,while pulmonary function recovered very slowly after surgery.Conclusion The normal appearance of chest wall can be recovered and normal cardiopulmonary function can be restored by the modified stemal elevation procedure in children with PE展开更多
Background:Pectus excavatum is the most common congenital chest wall deformity,with a high incidence in live births.This study aimed to evaluate the measured factors on CT images related to the number of pectus bars f...Background:Pectus excavatum is the most common congenital chest wall deformity,with a high incidence in live births.This study aimed to evaluate the measured factors on CT images related to the number of pectus bars for surgical correction.Methods:A total of 497 patients who had undergone minimally invasive repair between April 2007 and July 2011 were classified into single-bar(n=358)and doublebar(n=139)insertion groups.We measured eight distinct distances and one angle on CT scans to reflect quantitative assessment.Univariate analysis and multivariate logistic regression analysis were performed to detect statistically significant association between radiologic measurements and the pectus bars required.Results:After adjusting for age and gender,the transverse distance(T),the transverse distance of the depression area(A),the inclined distance of the depression area(B),the AP distance of the depression area(C),the depression angle(G),and the eccentric distance of deformity(E)were significantly correlated with double-bar insertion.The regression model showed that age(,P<0.0001),gender(P<0.0001),depression angle(G)(P<0.0001),direction of the depression(DD)(P<O.OOO1)and depression depth(D)(P<0.0001)were significantly associated with doublebar insertion.Conclusion:CT scan provides useful factors which can be of assistance in predicting the number of pectus bars for the surgical correction of pectus excavatum.展开更多
基金Research on Surgical Strategies for the Correction of Pectus Excavatum in Children via an Extrapleural Approach(Project No.:20220404021010)。
文摘Objective:To investigate the clinical efficacy and safety of the extrapleural approach versus the traditional intrathoracic approach in minimally invasive correction of pectus excavatum in children,providing a more scientific basis for selecting a more appropriate surgical method in clinical practice.Methods:This study included 50 children who underwent pectus excavatum correction at Harbin Children’s Hospital from January 2023 to January 2025.All patients were divided into two groups based on surgical approach:the observation group(n=26)and the control group(n=24).Children in the observation group underwent correction surgery via an extrapleural approach,while those in the control group underwent correction surgery via the traditional intrathoracic approach.Both groups underwent Nuss bar placement surgery under thoracoscopic guidance.Intraoperative indicators were compared between the two groups,including operative time,blood loss,pain scores at 24 and 48 hours postoperatively,hospital stay duration,thoracic correction outcomes,and the incidence of complications during a 6-month postoperative follow-up.Results:The intraoperative blood loss in the observation group was significantly lower than that in the control group(p<0.05),and the pain scores at 24 and 28 hours postoperatively were also significantly lower(p<0.05).The improvement in thoracic index postoperatively was relatively similar between the two groups,with no statistically significant difference(p>0.05).During the 6-month postoperative follow-up period,no complications such as pneumothorax,hemothorax,pleural effusion,plate displacement,or infection occurred in the observation group,whereas the overall complication rate in the control group was 25%,showing a significant difference(p<0.05).Conclusion:The extrapleural approach for corrective surgery can ensure the efficacy of thoracic deformity correction while reducing intraoperative blood loss,lowering the incidence of complications,alleviating postoperative pain,and accelerating recovery.It is a safe and effective approach for minimally invasive Nuss correction of pediatric pectus excavatum.
文摘Background: Adolescents with pectus excavatum (PE) are often affected by their body shape. The aim of our approach was to quantify the patients’ individual psychological distress and to create a psychological indication for treatment. Methods: 10 adolescents (8 male, median age 16 years, interquartile range 15 - 17 yrs.) with PE were examined at our psychological department. Using standardized psychological tests, projective tests and interviews psychologists validated the patients’ individual psychological status. All patients were offered psychological therapy and correction of the deformity. In addition, the children were followed-up by a telephone questionnaire (median follow-up after starting therapy 12.8 months (5.9 - 18.0). Results: No patient had a relevant physiological limitation. The median follow-up since presentation to our psychologists was 15.0 months (9.1 - 20.6). 8 patients (5 were operated, 2 used the vacuum bell, 1 will undergo surgery) had distinct psychological limitations especially concerning the dimensions attractiveness, self-esteem and somatisation. They demonstrated increased insecurity, anxiety and denegation of their body. Since all patients were within puberty the psychological distress due to the PE has to be interpreted as disadvantageous for their further development. 7 patients completed the follow-up questionnaire and reached a median score of 80.8% (76.4% - 86.8%), which indicates a good improvement in all patients. Conclusions: We conclude that the psychological indication for treatment is justified, since our results support this indication.
基金supported by National Science & Technology Pillar Program during the 12th Fiveyear Plan Period(No.SQ2011SF12C03081)
文摘Background Thoracoscopic minimally invasive pectus excavatum repair （Nuss operation） features its little trauma, simple, short operation time, and good outcome compared with traditional treatment of pectus excavatum surgery-sternal elevation （Ravitch operation） and sternal turnover. The effect of the operation on patients＇ heart and heart function remains unclear. This study aimed to understand the changes of electrocardiogram and cardiac function after Nuss procedure. Methods From 2008 January to 2013 July, thoracoscopic Nuss operation was performed in 217 patients with pectus excavatum. All the patients underwent the preoperative, postoperative detection of ECG and cardiac function in 3 months to 1 year after operation. Results After 3 months to 1 year follow-up, arrhythmias persisted in 46 out of 135 patients with preoperative symptoms （P 〈 0.05）; Stroke volume and cardiac output significantly increased （P 〈 0.05）; And cardiac parameters greatly improved （P 〈 0.05）. Conclusions Minimally invasive repair of pectus excavatum deformity can correct the chest malformation, alleviate arrhythmia, and improve cardiac function.
文摘Objective To study the application CT scans in Nuss procedure for pectus excavatum. Methods 648 children with pectus excavatum underwent Nuss procedure from July 2002 to September 2008. The preoperative CT scan was carried out for evaluation of the deformity degree and morphology classification of chest wall malformation,
文摘Objective To investigate the indication,feasibility and technique of minimally invasive Nuss procedure with thoracoscope by using double braces in the treatment of wide-scope pectus excavatum repairing in adolescence. Methods 31 patients including 24 boys and 7 girls,suffered from pectus excavtum were corrected by Nuss procedure under thoracoscope. The average age
文摘Objective To assess whether and to what extent pulmonary function returns to normal after surgical correction for pectus excavatum Methods Twenty seven patients who could be examined in person at the outpatient department of our hospital were included in this study Of these patients, 24 were boys and 3 were girls, with age ranging from 3 to 16 years (mean: 8 67 years) The mean age at surgery was 4 years and mean years at follow up was 6 8 Pulmonary function measurements included inspiratory vital capacity (IVC), total lung capacity (TLC), residual volume (RV), functional residual capacity (FRC), RV/TLC ratio, maximal voluntary ventilation (MVV), forced ventilatory capacity (FVC), forced expiratory volume in one second (FEV 1), maximal mid expiratory flow (MMEF), maximal expiratory flow at 75% vital capacity (V 75 ), maximal expiratory flow at 50% vital capacity (V 50 ), maximal expiratory flow at 25% vital capacity (V 25 ) and breathing reserve ratio (BR) Results TLC, FRC, MVV, MMEF, V 75 and V 50 were not different from normal values IVC, FVC, FEV 1 and V 25 were significantly decreased compared with normal values RV and RV/TLC were high in 87 5% cases Conclusions Preoperative symptoms improved substantially after operation Little airway obstruction was observed postoperatively, suggesting that patients with pectus excavatum should have surgery as early in life as possible, preferably by age 3
文摘Objective To describe our experience in the treatment of pectus excavatum(PE)using a modifed stemal elevation procedure.Methods From Oct.1986 to Dec.1997,171 patients with PE were admitted to the Department of Pediatric Surgery of the First Hospital of West China University of Medical Sciences.All patients were diagnosed through a history and physical examination.Cardiopulmonary function was assessed by M-mode echocardicgraphy and instrument of pulmonary function in 40 patients before and 4.2 years after surgery which was performed between 1989 and 1994.We performed the following three procedures in the stemal elevation:(1)forming the metal strut in a“arch”shape,(2)suturing the perichondrium into a“pipe”shape,and(3)encouraging patients to do chest expansion exercise after operation.All patients were followed up for 1 to 12 years.Results The normal contour of the costal cage was enlarged in all but one patient.Exercise tolerance was improved,and cardiac function recovered to the same level as in healthy children,while pulmonary function recovered very slowly after surgery.Conclusion The normal appearance of chest wall can be recovered and normal cardiopulmonary function can be restored by the modified stemal elevation procedure in children with PE
基金supported by a grant from the Research Foundation of Korea University(K1220231)
文摘Background:Pectus excavatum is the most common congenital chest wall deformity,with a high incidence in live births.This study aimed to evaluate the measured factors on CT images related to the number of pectus bars for surgical correction.Methods:A total of 497 patients who had undergone minimally invasive repair between April 2007 and July 2011 were classified into single-bar(n=358)and doublebar(n=139)insertion groups.We measured eight distinct distances and one angle on CT scans to reflect quantitative assessment.Univariate analysis and multivariate logistic regression analysis were performed to detect statistically significant association between radiologic measurements and the pectus bars required.Results:After adjusting for age and gender,the transverse distance(T),the transverse distance of the depression area(A),the inclined distance of the depression area(B),the AP distance of the depression area(C),the depression angle(G),and the eccentric distance of deformity(E)were significantly correlated with double-bar insertion.The regression model showed that age(,P<0.0001),gender(P<0.0001),depression angle(G)(P<0.0001),direction of the depression(DD)(P<O.OOO1)and depression depth(D)(P<0.0001)were significantly associated with doublebar insertion.Conclusion:CT scan provides useful factors which can be of assistance in predicting the number of pectus bars for the surgical correction of pectus excavatum.
