Анализ лечения детей с воронкообразной деформацией грудной клетки. Наш опыт, эволюция хирургического подхода и результаты лечения

Abstract

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.