漏斗胸NUSS手术

14. Chest radiography is performed after surgery to confirm good lung expansion and to reveal the final positioning of the bar.
Outcomes and Complication

Background NhomakorabeaPectus excavatum (漏斗胸), also known as funnel chest, is a congenital chest wall deformity in which several ribs and the sternum grow abnormally, producing a concave, or “cavedin” appearance in the anterior chest wall.

Until the mid 1990s, the operative treatment of pectus excavatum had been fairly well standardized and was based on the open operation originally described by Ravitch in 1949. The procedure is performed via an anterior (submammary) chest wall exposure, creation of muscle and skin flaps, extensive resection of the affected cartilages , and sternal osteotomy. Frequently, a transverse stainless steel plate or an artificial mesh is placed to support the sternum during the healing phase.

The deformity can be diagnosed at a very young age or, more commonly, it may only become noticeable in puberty and early adolescence.


Pectus excavatum is the most common type of congenital chest wall abnormality (90%), followed by pectus carinatum (5%-7%), and other less common anomalies Pectus excavatum occurs in an estimated 1 in 300-400 births,M-to-F ratio of 3:1.

Contact sports should be avoided for at least 6 months; The bar generally remains implanted for 2 to 3 years and is removed as an outpatient procedure under anesthesia.
Minimally Invasive Repair of Pectus Excavatum (NUSS technique)
Procedures
1. 2.
supine position with both arms abducted at the shoulders; Marked the deepest portion of the pectus on the corresponding intercostal spaces on the right and left sides;
8. An S-shaped device is inserted through the appropriate right intercostal space at the top of the pectus ridge; 9. The introducer is slowly advanced across the anterior mediastinal space immediately under the sternum with careful videoscopic guidance.

sternal turnover operation The entire anterior sternum and ribs are mobilized and turned 180° to allow for correction of the chest deformity.


In 1987,Donald Nuss performed the first minimally invasive operation for the correction of pectus excavatum. Not until May of 1997 was this new and innovative technique introduced to the American Pediatric Surgical Association and, subsequently, published in the Journal of Pediatric Surgery.
Normal measurement is around 2.5. An index of more than 3.2 has been correlated with a severe deformity that frequently requires surgery. • Plain anteroposterior and lateral chest radiography.
12. The bar is turned over so the concave part faces posteriorly (to the mediastinum) and the convex part faces anteriorly (against the sternum). 13. The stabilizer serves to limit rotation of the pectus bar, and it is sutured around the bar and to the muscle only after being properly fitted. (a third point-of-fixation suture)

小贴士
漏斗指数:漏斗胸指数：FI=（axbxc/AxBxC）a:凹陷的纵径；b:凹陷 的横径；c:凹陷的深度：A：胸骨的长度；B：胸廓的横径；C：胸骨
角至椎体的最短距离。
FI>0.3为重度；FI<0.2为轻度；FI：0.2~0.3为中度。
Treatment


Patients who present with cardiopulmonary impairment and/or are significantly affected and unable to function normally due to the presence of the chest wall malformation. The common goal of surgery is to correct the chest deformity resulting in physiological and psychological improvement.
10. Using the introducer, a strand of umbilical or tracheostomy cloth tape is pulled through the tunnel as a guide for placement of the pectus bar. 11. The bar is inserted with the convexity facing posteriorly such that the bar is between the sternum and the mediastinum.
Minimally Invasive Repair of Pectus Excavatum
From Thoracic and Cardiovascular Surgery 2010
CONTENTS
Background Clinical Presentation Imaging Studies Treatment Surgical Technique of NUSS Outcomes and Complication

psychological problems: self-esteem and body image perception are frequently reported in teenaged patients.
Imaging Studies

A chest CT scan without contrast is useful in determining the Haller index, which is derived by dividing the transverse chest diameter by the anteroposterior diameter.
3. The length of the Lorenz bar should be measured from the midaxillary line in 1 side to the opposite midaxillary line (30-38cm). 4. The curvature (convexity) of the bar is shaped to fit each individual patient’s chest;