- Analysis of treatment of children with pectus excavatum. Our experience, the evolution of surgical approach and treatment outcomes
Analysis of treatment of children with pectus excavatum. Our experience, the evolution of surgical approach and treatment outcomes
PAEDIATRIC SURGERY.UKRAINE.2018.1(58):85-89; doi 10.15574/PS.2018.58.85
Akselrov M. A., Razin M. P., Satyvaldaev M. N., Skobelev V. A., Skryabin Ye. G.
SFFEI of HPT «Tyumen State Medical University», Tyumen, the Russian Federation
SFFEI of HPT «Kirov State Medical University», Kirov, the Russian Federation
SFHI of TO «Regional Clinical Hospital No.2», Tyumen, the Russian Federation
SFHI of TO «Regional Clinical Hospital No.1», Tyumen, the Russian Federation
SFHI «Regional Children’s Clinical Hospital», Kirov, the Russian Federation
Pectus excavatum is the most common type of congenital chest wall abnormalities, which is observed in 0.6–2.3% of population and makes up 91% of all congenital chest deformities, and is often accompanied by severe functional disorders of the cardiovascular and bronchopulmonary systems. Discussions on the method of choice of thoracoplasty and fixation of the sternocostal complex are still ongoing until the present time.
Objective: to analyse the treatment outcomes of children with pectus excavatum and choose the most optimal method of thoracoplasty.
Material and methods. In the clinics of paediatric surgery of the Tyumen and Kirov State Universities during the period from 1990 to 2017, in total 209 children with pectus excavatum underwent surgical treatment. The indication for the operation was grade 2 and 3 according to the Gyzicka index (1962). The age of the patients varied from 4 to 18 (13.9±2.59) years old. There were 149 males. The patients were divided into two groups. The first group included 55 patients, operated according to the Bairov and Ravich technique. The second group comprised 154 children, who underwent thoracoplasty using the Nuss and Nuss-Vinogradov’s methods.
Results. Duration of the operation in the 1st group was 134±10.51 minutes and the 2nd one – 39±4.33 minutes. In the first group, thoracoplasty was accompanied by blood loss of 150 – 500 mL, whereas in the second group there was no blood loss during the intervention (no more than 10 mL). In the postoperative period, the pneumothorax occurred in 28 (93.3%) children of the 1st group (all of these patients required the pleural drainage) and in 8 (6.35%) patients of the 2nd group, and only 5 (3.96%) of the latter required a pleural drainage. In the 1st group pain-reliefs were administrated up to 10 days and antibiotic therapy was prescribed up to 14 days on average, while in the 2nd group – the analgetic and antibiotic therapies continued up to 3-5 days. The average hospital stay in the first group was 41±4.42 days and in the second – 9±1.82 days. In three patients of the 1st group there was a relapse of the disease, which required repeated thoracoplasty. At the moment, the plate is removed in 37 (40.7%) patients of the 2nd group. Removal of the plate is carried out in 2-9 years after the initial correction, on average 4.83±2.48 years after installation. In the postoperative period, the patients were provided check-up examination in dynamics in 1, 6 and 12 months and then once a year.
Conclusions. The correction procedure of pectus excavatum according to Nuss is safe and effective that allows obtaining a good cosmetic outcome and can be considered as a surgery of choice in the treatment of children.
Key words: children, pectus excavatum, thoracoplasty, fixation of the sternocostal complex.
1. Kozlova SI, Demikova NS i dr. (1987). Nasledstvennyie sindromyi i mediko-geneticheskoe konsultirovanie. Leningrad: Meditsina: 28–29.
2. Romero R, Pilu Dzh i dr. (1974). Prenatalnaya diagnostika vrozhdennyih porokov razvitiya ploda. Moskva: Meditsina: 412–414.
3. Akselrov M.A., Sitko L.A., Kuzhelivskiy I.I. (2015). Plastika grudinno-rebernogo kompleksa s ispolzovaniem titanovyih implantov pri deformatsii grudnoy kletki u detey i podrostkov. Voprosyi rekonstruktivnoy i plasticheskoy hirurgii. 3 (54): 36–38.
4. Ashkraft K.U., Holder T.M. (1996). Detskaya hirurgiya. – Sankt-Peterburg. T.1: 168–184.
5. Bisenkov L.N. (red.). (2004) Torakalnaya hirurgiya. Rukovodstvo dlya vrachey. Sankt-Peterburg: ELBI-SPb.
6. Vinogradov A.V. (2004). Deformatsiya grudnoy kletki u detey (hirurgicheskoe lechenie i mediko-sotsialnaya reabilitatsiya). Moskva, 38.
7. Vishnevskiy A.A., Rudakov S.S., Milanov N.O. (2005). Hirurgiya grudnoy stenki: Rukovodstvo. Moskva: ID «Vidar-M»: 35–78.
8. Geraskin V.I., Rudakov S.S., Vasilev G.S., Gerberg A.N. (1986). Magnitohirurgicheskaya korrektsiya voronkoobraznoy deformatsii grudnoy kletki. Moskva.
9. Kirgizov I.V., Plyankin V.A., Zlotnikov E.N., Strelnikov D.G. (2009). Sposob hirurgicheskogo lecheniya voronkoobraznoy deformatsii grudnoy kletki. Patent na izobretenie RUS 2400159 02.06.2009.
10. Kirgizov I.V., Plyankin V.A., Kirpichev S.V. (2008). Sravnitelnaya otsenka sposobov gemostaza pri operativnom lechenii vrozhdennoy voronkoobraznoy deformatsii grudnoy kletki. Rossiyskiy pediatricheskiy zhurnal, 5: 34–35.
11. Razumovskiy A.Yu., Alhasov A.B., Mitupov Z.B., Dallakyan D.N., Saveleva M.S. (2016). 15-letniy opyit lecheniya voronkoobraznoy deformatsii grudnoy kletki u detey. Detskaya hirurgiya, 20, 6: 284–287.
12. Saveleva G.V., Razumovskiy A.Yu. (2004). Torakoplastika po D. Nuss i ee modifikatsiya v raznyih stranah. Detskaya hirurgiya, 18, 1: 34–38.
13. Slizovskiy G.V., Maslikov V.M., Gyunter V.E., Titov V.M., Kuzhelivskiy I.I., Lukyanov A.I. (2011). Sposob hirurgicheskoy korrektsii voronkoobraznoy deformatsii grudnoy kletki u detey s ispolzovaniem materialov iz nikelida titana. Kubanskiy nauchnyiy meditsinskiy vestnik, 4 (127): 163–165.
14. Stalmahovich VN, Dyukov AA, Naymanov AP, Kaygorodova IN, Dudenkov VV. (2009). Novyie tehnologii v lechenii deformatsiy grudnoy kletki u detey. Sibirskiy meditsinskiy zhurnal, 89: 146–149.
15. Fischenko P.Ya., Vinogradov A.V., Sologubov E.G., Bosyih V.G. (2002). Hirurgicheskoe lechenie vrozhdennyih deformatsiy grudnoy kletki u detey. Almanah klinicheskoy meditsinyi, 5: 123–128.
16. Shamik VB. (2003). Optimizatsiya rekonstruktivnoy torakoplastiki pri vrozhdennyih deformatsiyah grudnoy kletki u detey i podrostkov. Rostov-na-Donu.
17. Kraspoulos G., Dusmet M, Labas G., Goldstraw P. (2006). Nuss procedure improves the quality of life in young male adults with pectus excavatum deformity. Europ. J. cardiothor. surg., 29: 1–5.
18. Razumovsky A.Yu., Bataev S.M., Alkhasov A., Mitupov Z., Ruchkov V., Stepanenko N. et al. (2016). Nuss procedure for treatment of pectus excavatum incyildren. Experince of 150 cases. In 5 TH WORLD CONGRESS OF PEDIATRIC SURGERY World Federation of Associations of Pediatric Surgeons: 210–211.