Еволюція методик хірургічної корекції лійкоподібної деформації грудної клітки в дітей: одноцентровий досвід

Abstract

Pectus excavatum (PE) in children is the most common pathology among orthopedic diseases of the anterior chest wall. Today in the world the main direction of scientific research in the surgical correction of this pathology is safety during surgery for the patient and the introduction of minimally invasive techniques. Purpose – to conduct a comparative analysis of the results of thoracoplasty in children with PE using different surgical techniques to reduce trauma and duration of surgery and blood loss; to study the optimal correction results to accelerate psycho-physical adaptation after the Nuss procedure. Materials and methods. The treatment of 289 patients operated on for PE in the orthopedic and traumatology department of National Children’s Specialized Hospital «OKHMATDYT» were analyzed. According to the methods of thoracoplasty used, patients were divided into 3 groups. In the first group (n=112) PE correction was performed using Nuss operation with subxiphoid access and tactile control during the retrosternal bar placement; in the second group (n=79) Nuss procedure was performed under thoracoscopic control, where one retrosternal T-shaped bar with additional lateral stabilizer was implanted and fixed on the ribs with a resorbable suture or wire; in the third group (n=98) surgical treatment of PE was performed using the Nuss procedure under thoracoscopic control using a fixator consisting of two retrosternal bars-arches, which are interconnected by lateral bars, the «Bridge» technique. Results. When using thoracoscopic control and temporary sternum elevation by modificated «Park crane» during the correction of PE, the time of surgery and blood loss was reduced. No rotations of the fixator throughout the observation period and lower postoperative pain syndrome were observed in patients of the 3rd group, who underwent corrections with the «Bridge technique». Conclusions. The technique of minimally invasive correction of pectus excavatum (MIRPE), Nuss operation, using thoracoscopic control and temporary elevation of the sternum during pectus bar placement is a safe and effective method of thoracoplasty. The use of two plates (the «Bridge» system) during minimally invasive correction is the operation of choice for adolescent children with funnel chest deformities. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: pectus excavatum; chest deformity; Nuss operation, surgery, pediatrics, thoracoplasty, results.