Early And Mid-term Effects On Cardiopulmonary Function Of Nuss Surgery For Children With Pectus Excavatum Postoperatively

[Objective]Congenital pectus excavatum is a common childhood thoracic deformity, the incidence rate of approximately0.1%-0.3%. Children sternal depression can lead to compression of the heart and lungs, causing reduced lung capacity, myocardial damage, and abnormal thoracic shape affect the mental health of children. The traditional surgical method to be cut off the rib cartilage, sternal osteotomy, sternal turnover or implanted needle plate, trauma, postoperative needle is easy to shift, lead to relapse. Nuss surgery is a minimally invasive repair of pectus excavatum surgery, the Nuss surgery in recent years for its trauma, postoperative effect has been greatly respected in the international arena, and quickly became the preferred surgical approach in today’s treatment of pectus excavatum. Home and abroad there is no positive indicators in the Nuss surgery, medium-term recovery in the early postoperative reports. In order to study the improvement of the the Nuss children after abnormal indicators, Kunming, Yunnan Province, Yan’an Hospital of Thoracic Surgery, admitted patients with pectus excavatum children for the study to explore the impact of the Nuss surgery on cardiopulmonary function to evaluate the surgery in pectus excavatum (PE) in the treatment effect.[Methods]According to domestic and foreign research reports, Nuss surgery in recent years become the main method of pectus excavatum surgery, about the Nuss surgery after abnormal indicators to restore and improve heart and lung function without a certain theory. Domestic studies have shown that preoperative examination can the anomaly index a recovery after3months to a year. Foreign reports suggest that postoperative6months to a year initially be corrected. Therefore, this study collected from January2010to November2012, live in Kunming, Yunnan Province, Yan’an Hospital of Thoracic Surgery and the implementation of minimally invasive pectus excavatum repair surgery (Nuss surgery) aged6-14years in30patients. Routinely collect inspection data before surgery,3months, after6months,1year after the collection of four stages, each stage a CT scan, pulmonary function tests, chest X-ray, echocardiogram, blood electrolyte examination, ECG and blood alkaline phosphatase check as positive indicators. SPSS16.0statistical analyze of the data results.[Results]1. Surgery completion:30cases of successful completion of the surgery, no mortality, no intraoperative complications; postoperative wound infection, strengthen anti-infective therapy cured;1patient after subcutaneous fluid through the puncture fluid cured; cases of postoperative pneumothorax, given the closed thoracic drainage after two days of rehabilitation. Preoperative symptoms:decreased exercise tolerance, fatigue, can not take a deep breath or shortness of breath, recurrent respiratory tract infections, heart palpitations and dizziness, the poor diet easy and vomiting, weight loss, etc., has been significantly improved.2. Haller index in children with preoperative much larger than the normal mean (2.52) to4.77±0.75mean the Nuss postoperative, Haller index was significantly lower after3months (2.05±0.21), after6months (2.09±0.20),1year after surgery (2.10±0.19) were significant differences in the preoperative, postoperative time Haller index rebounded slightly, but the difference was not significant after stage, and were within the normal range. Among them,1patient Nuss after3months, Haller index is still higher than the normal average, but within the normal range.3. Preoperative varying degrees with the phenomenon of scoliosis in children with18cases, is not accompanied by children with scoliosis,12cases (60%). Postoperative three months and one year after the review, with the spine in children with scoliosis in17cases,13cases with scoliosis.6months after surgery with scoliosis in children in16cases. Table2. Result, P>0.05four-stage scoliosis phenomenon no significant change.4. Children with varying degrees of preoperative ECG showed right bundle branch block complete or incomplete, T wave abnormalities, sinus arrhythmia in28cases, only two cases of children with normal ECG prompt. The preoperative examination ECG changes30patients before surgery of13cases (43.33%) T wave abnormalities, of which10cases (33.33%), incomplete right bundle branch block,5cases (16.67%) sinus arrhythmia; after three-stage review of ECG still prompt patients with normal ECG,28cases of children with abnormal ECG change is still associated with abnormal ECG different types.5. Lung function indicators, the Nuss surgery on50%of vital capacity maximum mid-expiratory flow (MEF50), maximal voluntary ventilation (MVV) and ventilatory reserve (BR) difference is not significant (P>0.05), minute ventilation (MV) and residual volume (RV) was significantly different (P<0.05), other indicators are extremely significant difference (P<0.01)(Table3, Figure1). The minute ventilation (MV), Nuss after its value decreased after3months (147.1±32.8) and significant difference in preoperative (170.3±49.8), with the extension of the time after gradually recovered to the preoperative level after one year has reached (182.3±48.9) L/min, with preoperative difference was not significant. With Contrary to minute ventilation, residual volume (RV), Nuss after surgery, its value has increased after three months (87.1±11.3) and preoperative (79.8±11.2) were significantly different, with the surgery extension of time after falling gradually to the preoperative level, after6months,1year after surgery and before surgery were not significantly different.Tidal volume (TV),3months after surgery (129.2±14.1) compared with the preoperative tidal volume (139.9±7.4) decreased, the difference was highly significant (P<0.01), with the prolonged postoperative time tidal volume rose gradually to the preoperative level, after6months, after1year and3months postoperatively difference was extremely significant, significant difference after6 months and1year after surgery,6months after surgery After one year with the preoperative difference was not significant. The purposes of forced vital capacity (VC MAX), Nuss postoperative FVC decreased after3months (68.5±14.7) before surgery (82.0±11.5) difference was significant, with the time after the FVC gradual recovery and more than before surgery, after6months,1year after surgery with preoperative difference was not significant. Forced vital capacity (FVC), Nuss after surgery, forced vital capacity decreased3months after surgery (66.1±16.8) and the difference was significant preoperative (78.5±11.8), forced vital capacity, with the time after gradually increased, one year after the forced vital capacity more than before surgery, but the difference is not significant. One second forced expiratory volume (FEV1), after3months (65.9±13.9) compared with the preoperative (73.7±9.0), its value was significantly lower, the difference was highly significant, with the postoperative time extend, one second forced expiratory volume picked up significantly higher than before surgery,6months and1year after surgery with preoperative significant difference, and after6months and after1year the difference was not significant. Peak expiratory flow (PEF), Nuss postoperative meditation to reduce its value, after three months with the preoperative difference was significant, with time, the maximum expiratory volume in slow recovery, one year after the pick-up to preoperative levels after6months;1year after surgery with preoperative difference was not significant. Nuss surgery affect the results show that after25%of the peak expiratory flow rate decreases,3months after surgery with preoperative difference was significant, after6months,1year after surgery and25%of peak expiratory flow (MEF25) preoperative differences are not significant.75%of peak expiratory flow (MEF75), Nuss surgery, its value decreased3months after surgery with preoperative difference was significant, with the postoperative time, its value is returned to preoperative level, after6months,1year after surgery with preoperative differences are not significant. The Nuss surgery25%and75%of the mean peak expiratory flow (MEF75/25) affect the results show Nuss surgery, its value decreased after3months (59.9±7.8) before surgery (70.8±8.3) difference was very significant, with time, the value of rapid recovery to the preoperative level after6months (71.7± 8.9) and3months after surgery difference significant, no significant difference in the preoperative, their values after the trend stable after1year and6months after surgery, preoperative no significant difference. Total lung capacity (TLC), the Nuss surgery, a significant reduction in its value, after3months (68.6±13.1) and highly significant difference in preoperative (85.4±10.1), and then with time, its value increases gradually to the preoperative level, after6months,1year after surgery with preoperative differences are not significant.6. Nuss surgery on left ventricular end-diastolic volume (EDV) left ventricular posterior wall systolic thickening (LVP) and ventricular septal systolic thickening (SST) is not significant, significant impact on the remaining four indicators. Nuss postoperative cardiac index (CI), its value increased gradually after3months,6months after surgery with preoperative. There were no significant differences in postoperative and preoperative significant difference. The Nuss technique of cardiac output (CO),3months after surgery was significantly higher than the preoperative significant difference between the various stages of postoperative cardiac output was no significant difference. The stroke output volume (SV), the amount of output per Bo after significantly increased after3months (40.6±8.1) after6months (40.1±8.3), after1year (39.9±7.9) and preoperative (37.5±8.5) were significantly different, the difference was not significant after stage. Left ventricular ejection fraction (EF), the postoperative left ventricular ejection fraction was significantly increased after3months (66.0±2.7) significant difference between preoperative (63.2±2.8), as prolonged postoperative time, left ventricular ejection fraction did not change significantly.7. Routine testing in this group preoperative serum electrolyte, select calcium as the main outcome measures.30patients before surgery, after3months, after6months,1year after the four-stage test results were within the normal range (2.1to2.7mmol/L).8. Preoperative examination of30patients serum alkaline phosphatase were within the normal range (37℃, women from1to12years old<500U/L;>15years old40to150U/L.;1to12-year-old male<500U/L;12to15years old<750u/L;> 25years old40to150U/L), after3months,6months after surgery, one year after the three-stage review serum alkaline phosphatase in the normal range within. Preoperative examination separation of bone alkaline phosphatase (BALP) of22patients were measured value>200U/L, accounting for73.33%;12cases of greater than300U/L,40%; postoperative three stages of review, children The proportion of no change.9. Postoperative follow-up of12months,30cases of steel had no loose, good location, and pectus excavatum with improvement in symptoms. Various stages of the satisfaction rate above90%,3months after surgery satisfaction rate is slightly higher than after6months and after one year, and after6months and1year after the equal satisfaction of each stage no not satisfied with reoperation. The results also showed that, Nuss surgery, more than90%of children with pectus excavatum symptoms improved, and with prolonged postoperative time, the more obvious symptoms improved.[Conclusion]1. Nuss surgical trauma and faster recovery in the short run can significantly improve pectus excavatum patients before surgery, decreased exercise tolerance, fatigue, can not take a deep breath or shortness of breath, recurrent respiratory tract infections, heart palpitations and dizziness, poor food intake easy vomiting, weight loss and other symptoms.2. Nuss surgery before and after the CT index changed significantly, and the correction lasting effect; the CT index a good indicator of the effect of the evaluation of pectus excavatum orthopedic.3. The four stages of scoliosis in children phenomenon before and after the Nuss surgery did not change significantly, there may be associated with acquired scoliosis.4. Nuss surgery has been formed ECG abnormalities had no effect.5. Vital capacity maximum mid-expiratory flow (MEF50), maximal voluntary ventilation (MVV) and ventilatory reserve (BR) before and after the Nuss surgery did not change significantly. Minute ventilation (MV), residual volume (RV), of FVC (VCMAX), forced vital capacity (FVC), one second forced vital capacity (FEV1) after3months was significantly reduced after6months to1year gradually recovered and more than before surgery. Peak expiratory flow (PEF),1/4steps of maximum expiratory flow (MEF25),3/4steps of maximum expiratory flow (MEF75), MEF75/25postoperative decrease gradually restored to6months to1year preoperative levels.6. Nuss before and after surgery on left ventricular end-diastolic volume (EDV), left ventricular posterior wall systolic thickening (LVP) and ventricular septal systolic thickening (SST) is not obvious. Cardiac output (CO),3months after the stroke output (SV), cardiac index (CI) increased significantly after6months to1year continue to change.7. Nuss surgery no significant change in serum calcium content.8. Nuss surgery no significant change in serum alkaline phosphatase and bone alkaline phosphatase.9. Nuss over time after surgery, doctors and families of children with satisfactory surgical results.