Pektus ekskavatumda Nuss tekniğinin farklı yaş gruplarında klinik sonuçları

Yıl 2021, Cilt: 12 Sayı: 1, 1 - 6, 31.03.2021

Murat Akkuş , Tuba Apaydın

https://doi.org/10.18663/tjcl.749597

Öz

Amaç: 1998 yılında Donald Nuss minimal invaziv teknik olarak pektus ekskavatumda sternum arkasına metal bar yerleştirilmesini önermiştir. Bununla beraber hastaların yaşları ve klinik sonuçları ile ilgili veriler sınırlıdır. Bu çalışmanın amacı, farklı yaş grupları arasında pektus ekskavatumda Nuss cerrahisinin klinik sonuçlarını karşılaştırmak, bu prosedür için en uygun yaş aralığını vurgulamaktır.
Gereç ve Yöntemler: Şubat 2012 ile Ocak 2020 yılları arasında Nuss operasyonu ile tedavi edilen 140 olgu çalışmaya alındı. Olgular 3 grup olarak sınıfandırıldı: 15 yaşından küçük olgular (grup A), 15-20 yaş aralığında olanlar (grup B), 20 yaşından büyük 40 yaşa kadar (grup C) olarak sıralandı. Hastaların, demografik yapıları, cerrahi sonuçları, hastanede yatış süreleri ve komplikasyon oranları değerlendirilerek karşılaştırıldı.
Bulgular: Yüz on hasta erkek, 30 hasta kadındı. Erkek olgular, solunum sıkıntısı klinik şikayeti olan olgular en sık ileri yaş grubunda görüldü ve istatistiksel olarak anlamlı idi (p:0.003). Erken postoperatif 30 gün ölüm izlenmedi. En sık komplikasyon grup C (%40,9), takiben grup B (%18,2) ve grup A (%9,7) görüldü (p:0.007). Lojistik regresyon analizinde 20 yaş üstü olan olgularda postoperatif komplikasyonlar anlamlı olarak yüksek bulundu (p:0.003). Ergenlik döneminde bar çıkarılması sonrası nüks gelişen 2 grup A olgusuna Brace tedavisi uygulandı.
Sonuç: Nuss tekniği, düşük komplikasyon oranı, kısa süreli hastanede yatış ve tatminkar sonuçları ile tavsiye edilebilir. Çocukluk dönemi, komplikasyonlara bağlı uygun gibi görülmesine rağmen cerrahi, nüks oranı düşüklüğü nedeniyle ergenlik döneminde tercih edilebilir.

Anahtar Kelimeler

Nuss tekniği, Pektus ekskavatum, Minimal invaziv onarım pektus cerrahisi

Proje Numarası

-

Clinical results of Nuss procedure for pectus excavatum in different age groups

Öz

Aim: In 1998, Donald Nuss suggested the insertion of a metal bar behind the sternum for pectus excavatum as a minimally invasive technique. However, data regarding the relation between the age of the patient and clinical results of repair is limited. Aim of this study is to compare the clinical results of Nuss surgery for pectus excavatum in different age groups, to point out the optimal range of age for this procedure.
Material and Methods: From February 2012 to January 2020, data regarding 140 patients have been treated with Nuss surgery. We classified patients into three groups: patients younger than 15 years (group A), patients between 15 and 20 years (group B); and patients older than 20 years up to 40 years (group C) retrospectively. We evaluated patients' demographics, and compared results of surgery, duration of hospitalization and complication rates.
Results: One hundred ten patients were male and 30 were female. Male patients, clinical symptomatic patients with dyspnea in the preoperative period were seen more frequently in patients with older age, and each were statistically significant (p:0.003). In the early 30-day postoperative period, no mortality was observed. The most frequent postoperative complications were observed in group C (40,9%), followed by group B (18,2%) and group A (9,6%)(p:0.007). In logistic regression analysis, postoperative complications increased significantly in patients older than 20 years (p:0.003). Brace therapy was performed for 2 cases in Group A for recurrence after bar removal which occurred in adolescant period.
Conclusion: Nuss procedure can be recommended with low complication rates, short term hospitalization and high grade of success. Although the childhood period seems to be more suitable regarding the complications, surgery can be preferred with low recurrence rates in adolescant period.

Anahtar Kelimeler

Nuss Procedure, Pectus Excavatum, Minimally Invasive Repair of Pectus Excavatum

Destekleyen Kurum

yok

Proje Numarası

-

Teşekkür

-

Kaynakça

• 1. Nuss D, Kelly Jr RE, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. Journal of pediatric surgery. 1998; 33: 545-52.
• 2. Zhang D, Tang J, Ben X et al. Surgical correction of 639 pectus excavatum cases via the Nuss procedure. Journal of Thoracic Disease. 2015; 7: 1595-605.
• 3. Pawlak K, Gasiorowski L, Gabryel P, Galecki B, Zielinski P, Dyszkiewicz W. Early and late results of the Nuss Procedure in Surgical Treatment of Pectus Excavatum in different age groups. Annals of Thoracic Surgery. 2016; 102: 1711-16.
• 4. Pilegaard H.K.: Extending the use of Nuss procedure in patients older than 30 years. Eur J Cardiothorac Surg 2011; 40: 334-37.
• 5. Aronson DC, Bosgraaf RP, van der Horst C, ad Ekkelkamp S. Nuss procedure: pediatric surgical solution for adults with pectus excavatum. World J surg 2007; 31: 26-9.
• 6. Coln D, Gunning T, Rmasay M, Swygert T, and Vera R. Earlyexperience withtheNussminimally invasive correction of pectus excavatum in adults. World J Surg 2002; 26: 1217-21.
• 7. Haller JA, Jr. Scherer LR, Turner CS, Colombani PM. Evolving management of pectus excavatum based on a single institutional experience of 664 patients. Ann Surg 1989; 209: 578-82.
• 8. Papandria D, Arlikar J, Sacco Casamassima MG et al. Increasing age at time of pectus excavatum repair in children: emerging consensus? J Pediatr Surg 2013; 48: 191-6
• 9. Park HJ, Sung SW, Park JK, Kim JJ, Jeon HW, Wang YP. How early can we repair pectus excavatum: the earlier the better? Eur J Cardiothorac Surg 2012; 42: 667-72.
• 10. Fonkalsrud EW, Reemtsen B. Force required to elevate the sternum of pectus excavatum patients. J Am Coll Surg 2002; 195: 575-7.
• 11. Park HJ, Kim JJ, Park JK, Moon SW. Effects of Nuss procedure on thoracic scoliosis in patients with pectus excavatum. Journal of thoracic disease. 2017; 9: 3810-6.
• 12. Jaroszewski DE, Ewais MM, Chao CJ et al. Success of Minimally Invasive Pectus Excavatum Procedures (Modified Nuss) in Adult Patients (>/=30 Years). Ann Thorac Surg 2016.
• 13. Kim DH, Hwang JJ, Lee MK, Lee DY, Paik HC. Analysis of the Nuss procedure for pectus excavatum in different age groups. The Annals of thoracic surgery. 2005 ; 80: 1073-7.
• 14. Mao YZ, Tang ST, Wang Y, Tong QS, Ruan QL. Nuss operation for pectus excavatum: a single-institution experience. World Journal of Pediatrics. 2009 ; 5: 292.
• 15. Shu Q, Shi Z, Xu WZ at al. Experience in minimally invasive Nuss operation for 406 children with pectus excavatum. World Journal of Pediatrics. 2011 ; 7: 257.
• 16. Aronson DC, Bosgraaf RP, van der Horst C, Ekkelkamp S. Nuss procedure: pediatric surgical solution for adults with pectus excavatum. World journal of surgery. 2007 ; 31: 26-9.
• 17. Bosgraaf RP, van der Horst C, Ekkelkamp S. Nuss procedure: pediatric surgical solution for adults with pectus excavatum. World journal of surgery. 2007 ; 31: 26-9
• 18. De Matos AC, Bernardo JE, Fernandes LE, Antunes MJ. Surgery of chest wall deformities. European Journal of Cardiothoracic Surgery. 1997 ; 12: 345-50.
• 19. Cheng YL, Lee SC, Huang TW, Wu CT. Efficacy and safety of modified bilateral thoracoscopy-assisted Nuss procedure in adult patients with pectus excavatum. European journal of cardio-thoracic surgery. 2008 ; 34: 1057-61.
• 20. Peter SD, Sharp SW, Ostlie DJ, Snyder CL, Holcomb III GW, Sharp RJ. Use of a subxiphoid incision for pectus bar placement in the repair of pectus excavatum. Journal of pediatric surgery. 2010 ; 45: 1361-4
• 21. Park HJ, Chung WJ, Lee IS, Kim KT. Mechanism of bar displacement and corresponding bar fixation techniques in minimally invasive repair of pectus excavatum. Journal of pediatric surgery. 2008 ; 43: 74-8.
• 22. Hebra A, Jacobs JP, Feliz A, Arenas J, Moore CB, Larson S. Minimally invasive repair of pectus excavatum in adult patients. The American Surgeon. 2006 ; 72: 837-42.
• 23. Notrica DM. The Nuss procedure for repair of pectus excavatum: 20 error traps and a culture of safety. InSeminars in pediatric surgery 2019; 28: 172-77
• 24. Notrica DM. Modifications to the Nuss procedure for pectus excavatum repair: A 20-year review. InSeminars in pediatric surgery 2018; 27: 133.
• 25. Nuss D. Minimally invasive surgical repair of pectus excavatum. InSeminars in pediatric surgery 2008;17: 209-17.