The Research On The Pre-And Postoperative Chest Flat Degree And The Pulmonary Function In The Different Age Patients With Pectus Excavatum

Objective: Through the retrospective research of the pre- and postoperative chest flat degree and the pulmonary function in the different age patients with pectus excavatum, we investigate the relationship of the chest flat degree along with the age, and the pulmonary function before and after the surgery, then provide the information for the ideal age for surgery.Methods: (1) Measurements of chest flat degree:25 patients of 1-3 years old , 25 patients of 3-6 years old , 20 patients of older than 6 years, all the patients were treated with modified Ravitch procedure. Chest X-ray of AP view and lateral view were taken in all the patients before surgery and after 2 years following the surgery, the chest flat index was anteroposterior diameter of the thorax (diaphragmatic level) divided by the transverse diameter of the thorax (the distance from the posterior border of 2nd body sternum top to spine). The same amount of normal children compared with the patients who has the similar age, sex, height, weight were selected as control group before and after the surgery, and the other batch of non-surgery children compared with the patients who has the similar age, sex, height, weight were selected as control group after the surgery. The control group were measured as the same way. (2) Pulmonary function test: all the above patients's pulmonary function were tested before surgery and after 2 years following the surgery [before bar removal]. In the patients from 1-3 years old, the preoperative normal value came from the same amount of children who had the similar age, sex, height and weight, and the postoperative normal value came from the individual normal predicted values. In the patients from 3-6 years old and older than 6 years, the pre- and postoperative normal values came from the individual normal predicted values.Results: (1) The chest flat index in the different age control group was not significantly different(P>0.05);the chest flat index between the preoperative and control group was significantly different(P<0.05),the preoperative chest index between the different age was significantly different(P<0.05),the older patients , the bigger chest index. The chest index between the postoperative and control group was significantly differen(tP<0.05),the chest flat index was not completely recovered. The chest flat index between postoperative group and non-surgery control group was significantly different(P<0.05), and the chest flat index decreased after the procedure. Furthermore, postoperative chest value was smaller in the younger group. (2) 1-3 years old group were compared with the control group: %V-PF,V25/PF decreased and TE/TI increased, the difference was significan(tP<0.05);3-6 years group and older than 6 years group were compared with normal predicted value, the indexes of pulmonary function were significantly different(P<0.05), Furthermore, the difference between normal predicted values and actual values of the 3-6 years group was significant lower than that of the older than 6 years group;the difference was not significant between 1-3 years old group and predicted value after 2 years following the surgery(P>0.05); FEV1 ,V50,V25 in the 3-6 years old group were still lower than normal predicted values after 2 years following the surgery, the difference was significant(P<0.05),VC,V75,PEF, FEV1 ,V50,V25 in older than 6 years group were lower than the predicted values, the difference was significant(P<0.05)。Conclusions: (1) The patients's throax with pectus excavatum were flatter than the normal children, furthermore, the chest flat degree exacerbated along with the age. (2) After 2 years following the surgery, the chest flat index hadn't reached to the normal level, but had been improved significantly compared with the same age non-surgery control group, the effect was better in the younger group.(3) The pulmonary function was damaged in the different age groups, but better in the younger group.(4) After 2 years following the surgery, the pulmonary function indexes in 1-3 years old group recover to the normal level. But the small airway function had been impaired obviously in the 3-6 years old group. In the group of older than 6 years, the small and big airway functions are both impaired obviously.(5) According to our studies,we consider that the repair of pectus excavatum should be applied in earlier period, the ideal age for surgery is the period of 1-3years old.