Correction of Pectus Excavatum by Non-thoracoscopic Nuss Procedure in 51 Patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIUYu ¹ ,  ZOUZhi-qiang ¹ , YangLu ² , LIChuan-hai ¹

1. Department of Thoracic Surgery, Jinan Military General Hospital, Jinan 250031, P. R. China;
2. Department of Pediatrics, Jinan Children's Hospital, Jinan 250022, P. R. China;

Corresponding author：

ZOUZhi-qiang, Email: zdyddy2000@tom.com

Keywords：

Pectus excavatum; Mini-invasive Nuss procedure; Non-thoracoscopic surgery

DOI：

10.7507/1007-4848.20150039

Video：

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Objective To summarize clinical experience of minimally invasive non-thoracoscopic Nuss procedure for the treatment of pectus excavatum (PE). Methods Fifty-one pediatric patients received minimally invasive nonthoracoscopic Nuss procedure for PE between July 2008 and February 2014 in Department of Thoracic Surgery, Jinan Military General Hospital. There were 32 males and 19 females with their average age of 8.32 (2.5-17.0) years. Transverse incisions were made in bilateral chest wall. Supporting plate was put to right chest wall through retrosternal approach, turned over and fastened onto the ribs. Results Deformity of all the patients was successfully corrected. Operation time was 30-52 (38±9) minutes. One patients had heart injury which was repair after open thoracotomy, and then supporting-plate was successfully secured. Postoperative complications included subcutaneous emphysema in 7 patients, pneumothorax in 3 patients and atelectasis in 3 patients, all of whom were cured by conservative treatment. Supportingplate transposition occurred in 1 patient and was corrected by reoperation. All the patients were followed up for 1-42 (21.6±7.6) months. According to Nuss standard, there were 39 patients with excellent results, 9 patients with good results, and 3 patients with fair results. Conclusion Minimally invasive Nuss procedure is an efficacious, easy, feasible and safe procedure for the treatment of PE with low morbidity.

Citation： LIUYu, ZOUZhi-qiang, YangLu, LIChuan-hai. Correction of Pectus Excavatum by Non-thoracoscopic Nuss Procedure in 51 Patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(2): 139-142. doi: 10.7507/1007-4848.20150039 Copy

1.	Molik KA, Engum SA, Rescorla FJ, et al. Pectus excavatum repair:experience with standard and minimal invasive techniques. J Pediatr Surg, 2001, 36(2):324-328.
2.	Malek MH, Fonkalsrud EW, Cooper CB, et al. Ventilatory and cardiovascular responses to exercise in patients with pectus excavatum. Chest, 2003, 124(3):870-882.
3.	Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4):545-552.
4.	曾骐, 张娜, 范茂槐, 等. Nuss手术与改良Ravitch手术的对比研究.中华小儿外科杂志, 2005, 26(8):397-399.
5.	施诚仁, 金先庆, 李仲智, 主编.小儿外科学.第4版.北京:人民卫生出版社, 2009. 190-192.
6.	钟竑, 张辅贤, 梅举, 等.微创Nuss手术治疗漏斗胸复发患者12例.中国胸心血管外科临床杂志, 2010, 17(2):153-155.
7.	王宗林, 戴天阳, 祝淮阳, 等. 34例漏斗胸的外科治疗.中国胸心血管外科临床杂志, 2005, 12(5):365.
8.	Tang M, Nielsen HH, Lesbo M, et al. Improved cardiopulmonary exercise function after modified Nuss operation for pectus excavatum. Eur J Cardiothorac Surg, 2012, 41(5):1063-1067.
9.	Park HJ, Lee SY, Lee CS, et al. The Nuss procedure for pectus excavatum:evolution of techniques and early results on 322 patients. Ann Thorac Surg, 2004, 77(1):289-295.
10.	Engum S, Rescorla F, West K, et al. Is the grass greener? Early results of Nuss procedure. J Pediatr Surg, 2000, 35(2):246-251.
11.	Nuss D. Recent experiences with minimally invasive pectus excavatum repair"Nuss procedure". Jpn J Thorac Cardiovasc Surg, 2005, 53(7):338-344.
12.	Pilegaard HK, Licht PB. Early results following the Nuss operation for pectus excavatum, a single institution experience of 383 patients. Interact Cardiovasc Thorac Surg, 2008, 7(1):54-57.
13.	Dzielicki J, Korlacki W, Janicka I, et al. Difficulties and limitations in minimally invasive repair of pectus excavatum-6 years experiences with Nuss technique. Eur J Cardiothorac Surg, 2006, 30(5):801-804.
14.	刘文英, 徐冰, 吉毅, 等.非胸腔镜辅助Nuss手术矫治漏斗胸.中华外科杂志, 2008, 46(8):567-569.
15.	Kelly RE, Goretsky MJ, Obermeyer R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg, 2010, 252 (6):1072-1081.
16.	Nuss D, Kelly RE Jr. Indications and technique of nuss procedure for pectus excavatum. Thorac Surg Clin, 2010, 20(4):583-597.
17.	Croitoru DP, Kelly RE Jr, Goretsky MJ, et al. Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. J Pediatr Surg, 2002, 37(3):437-445.
18.	鲁亚南, 刘锦纷, 徐志伟, 等.改良Nuss手术纠治小儿漏斗胸.中华胸心血管外科杂志, 2007, 14(2):93-96.
19.	Jaroszewski D, Notrica D, McMahon L, et al. Current management of pectus excavatum:a review and update of therapy and treatment recommendations. J Am Board Fam Med, 2010, 23(2):230-239.
20.	李斌, 张建华, 苟云久, 等.胸腔镜辅助下Nuss手术微创矫治漏斗胸的疗效观察.中国修复重建外科杂志, 2013, 27(5):586-589.
21.	Moss RL, Albanese CT, Reynolds M. Major complications after minimally invasive repair of pectus excavatum:case reports. J Pediatr Surg, 2001, 36(1):155-158.
22.	刘吉福, 武珊珊, 徐波, 等. 152例成人漏斗胸的微创治疗-近期并发症分析及处理.中国微创外科杂志, 2012, 12(1):43-46.
23.	Park HJ, Lee SY, Lee CS. Complications associated with the Nuss procedure:analysis of risk factors and suggested measures for prevention of complications. J Pediatr Surg, 2004, 39(3):391-395.
24.	Teh SH, Hanna AM, Pham TH, et al. Minimally invasive repair for pectus excavatum in adults. Ann Thorac Surg, 2008, 85(6):1914-1918.

1. Molik KA, Engum SA, Rescorla FJ, et al. Pectus excavatum repair:experience with standard and minimal invasive techniques. J Pediatr Surg, 2001, 36(2):324-328.
2. Malek MH, Fonkalsrud EW, Cooper CB, et al. Ventilatory and cardiovascular responses to exercise in patients with pectus excavatum. Chest, 2003, 124(3):870-882.
3. Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4):545-552.
4. 曾骐, 张娜, 范茂槐, 等. Nuss手术与改良Ravitch手术的对比研究.中华小儿外科杂志, 2005, 26(8):397-399.
5. 施诚仁, 金先庆, 李仲智, 主编.小儿外科学.第4版.北京:人民卫生出版社, 2009. 190-192.
6. 钟竑, 张辅贤, 梅举, 等.微创Nuss手术治疗漏斗胸复发患者12例.中国胸心血管外科临床杂志, 2010, 17(2):153-155.
7. 王宗林, 戴天阳, 祝淮阳, 等. 34例漏斗胸的外科治疗.中国胸心血管外科临床杂志, 2005, 12(5):365.
8. Tang M, Nielsen HH, Lesbo M, et al. Improved cardiopulmonary exercise function after modified Nuss operation for pectus excavatum. Eur J Cardiothorac Surg, 2012, 41(5):1063-1067.
9. Park HJ, Lee SY, Lee CS, et al. The Nuss procedure for pectus excavatum:evolution of techniques and early results on 322 patients. Ann Thorac Surg, 2004, 77(1):289-295.
10. Engum S, Rescorla F, West K, et al. Is the grass greener? Early results of Nuss procedure. J Pediatr Surg, 2000, 35(2):246-251.
11. Nuss D. Recent experiences with minimally invasive pectus excavatum repair"Nuss procedure". Jpn J Thorac Cardiovasc Surg, 2005, 53(7):338-344.
12. Pilegaard HK, Licht PB. Early results following the Nuss operation for pectus excavatum, a single institution experience of 383 patients. Interact Cardiovasc Thorac Surg, 2008, 7(1):54-57.
13. Dzielicki J, Korlacki W, Janicka I, et al. Difficulties and limitations in minimally invasive repair of pectus excavatum-6 years experiences with Nuss technique. Eur J Cardiothorac Surg, 2006, 30(5):801-804.
14. 刘文英, 徐冰, 吉毅, 等.非胸腔镜辅助Nuss手术矫治漏斗胸.中华外科杂志, 2008, 46(8):567-569.
15. Kelly RE, Goretsky MJ, Obermeyer R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg, 2010, 252 (6):1072-1081.
16. Nuss D, Kelly RE Jr. Indications and technique of nuss procedure for pectus excavatum. Thorac Surg Clin, 2010, 20(4):583-597.
17. Croitoru DP, Kelly RE Jr, Goretsky MJ, et al. Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. J Pediatr Surg, 2002, 37(3):437-445.
18. 鲁亚南, 刘锦纷, 徐志伟, 等.改良Nuss手术纠治小儿漏斗胸.中华胸心血管外科杂志, 2007, 14(2):93-96.
19. Jaroszewski D, Notrica D, McMahon L, et al. Current management of pectus excavatum:a review and update of therapy and treatment recommendations. J Am Board Fam Med, 2010, 23(2):230-239.
20. 李斌, 张建华, 苟云久, 等.胸腔镜辅助下Nuss手术微创矫治漏斗胸的疗效观察.中国修复重建外科杂志, 2013, 27(5):586-589.
21. Moss RL, Albanese CT, Reynolds M. Major complications after minimally invasive repair of pectus excavatum:case reports. J Pediatr Surg, 2001, 36(1):155-158.
22. 刘吉福, 武珊珊, 徐波, 等. 152例成人漏斗胸的微创治疗-近期并发症分析及处理.中国微创外科杂志, 2012, 12(1):43-46.
23. Park HJ, Lee SY, Lee CS. Complications associated with the Nuss procedure:analysis of risk factors and suggested measures for prevention of complications. J Pediatr Surg, 2004, 39(3):391-395.
24. Teh SH, Hanna AM, Pham TH, et al. Minimally invasive repair for pectus excavatum in adults. Ann Thorac Surg, 2008, 85(6):1914-1918.

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Correction of Pectus Excavatum by Non-thoracoscopic Nuss Procedure in 51 Patients

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