The Clinical Analysis Of Pectus Excavatum Funnel Chest Under 6 Years Old

Objective:By summing up the experience of surgical treatment of Pectus excavatum funnel chest under 6 years old. we explore the appropriate approach in different classifications in order to improve the level of clinical diagnosis and treatment of this disease.Materials & Methods:Retrospectivly review 578 cases(457 cases were integral) diagnosed as Pectus excavatum funnel chest which accepted surgical treatment simuleaneously from May 1,2005 to December 31,2014 in Chongqing Medical University Children’s Hospital.Of which the children under 3 years old is 239 cases,children between 3-6 years old with modified Ravitch is 218 cases as well as 100 cases with Nuss procedure.At the same time analysis the relationship between factors including age, medical manifestation, severity, shape, different surgical procedures, complications and outcome of children.Results:1.There are 239 cases between 11months to 3 years old with modified Ravitch invented by we hospital.The average operation time is 85.47± 27.15 min,The average blood loss is 2.31±3.45ml, the average transfusion is 2.11±5.47ml, there are not any serious short term complications occured2. Comparing the group with modified Ravitch under 3 years old and healthy children under 3 years old in lung function.Difference between the two groups among TE/TI、V-PF、25/PF before surgery and the difference disappears after surgery. Comparing the group from 3 to 6 years old and healthy children in the same age in lung function.There are all weaker before surgery while V50 and V25 were not changed after surgery. No difference was observed by FI classification in modified Ravitch group while the sever group appears to be different with the rest group in Nuss procedure.3.The assessment of outcome seems to be the same in mild and moderate group with satisfaction while modified Ravitch shows advan tages in severe group.4.The assessment of outcome between 3 to 6 years old reports a s follow:Symmetrical group reaches perfect results in both group me anwhile some asymmetrical group is inclined to modified Ravitch for recovery.Conclusion:1 The children with PE between lto 3 years old using modified Ravitch invented by we hospital results in perfect outcome.2.The lung function in the group between 1 to 3 years old will recover to normal in 2years after surgery while the group between 3 to 6 years old still comes to ventilatory dysfunction in small airway.The FI classification has no influence in modified Ravitch group while the severe group in Nuss procedure appears to be more serious than rest of the group.3.The outcome in severe group in modified Ravitch group appears to be better than the one in Nuss procedure.4.The outcome in asymmetrical group in modified Ravitch group appears to be better than the one in Nuss procedure.5.All in all, we recommend:A. Children under 3 years old contains two or more aspects as follows are suitable for surgery:1) Haller index>3.2 or FI>0.3.2) Recurrent Respiratory Tract Infections、pneumonia、 pulmonary atelectasis or restrictive ventilatory impairment.3) ECG shows RBBB、ST-T segment changes or UCG shows heart valve prolapse and other significative abnormalities.4) The severity appears to be worse. B、 Children from 3-6 years:1) Severe group and asymmetrical group tend to be modified Ravitch.2)Mild or moderate group with flat chest tend to be Nuss procedure.