MSCT Evaluation Of Different Age Groups Pre And Postoperative Small Airway Change Of Pectus Excavatum And The Correlation Analysis Between It And Pulmonary Function Test

Objective:By summing up and analysing the pre and postoperative clinical data of 61 cases pectus excavatum patients,to research MSCT evaluation of different age groups pre and postoperation small airway change of pectus excavatum and the correlation between it and pulmonary function test,provide a reference for clinic.Matarials&Methods:Retrospectivly review 61 cases of congenital pectus excavatum patients which accepted surgical treatment and postoperative removed the steel plate from January 1,2005 to December 31,2015.Of which the male contribute to 50 cases,the female 11 cases.The preoperative age range from 1.83 to 16.75 years old,average age is(7.32±4.45)years old.Of which the children under-3-years-old group make up 11 cases, 3-6-years-old group 21 cases,over-6-years-old group 29 cases.By Haller index,the mild group contribute to 4 cases,the moderate group is 14 cases,the severe group is 43 cases.To detection the pre and postoperative pulmonary function, observe the small airway changes of MSCT.On infant pulmonary function we set the pre-operative tidal pulmonary function of polydactylism patients without any cardiopulmonary disease in our hospital as control,on routine pulmonary function we set the predicted values as control. We research the change of the small airway change of MSCT and the change of pulmonary function between pre-operation and postoperative,and the correlation analysis between the small airway change of MSCT and pulmonary function test.Result:1.In the under-3-years-old group,the pre-operative small airway change rate of MSCT is 3/11(27.3%),postoperative is 0/11(0%),no significant difference,P>0.05.The pre-operative pulmonary function find that t PTEF%t E、VPEF%VE、PTEF as% TEF25 are significant different compared with the control group, P<0.01. The postoperative pulmonary function compared with the predicted values find the VC is lower than normal, P<0.05.2.In the 3-6-years-old group, the pre-operative small airway change rate of MSCT is 7/21(33.3%),postoperative is 1/21(4.8%),with statistical significance,P<0.05.The pre-operative pulmonary function find VC、MMEF are lower than the predicted values, and the difference is significant, P<0.01,MEF50、MEF25 are lower too, P<0.05.Postoperative tests find VC、MEF50 are lower than normal,the differences are significant, P<0.01, and FVC 、 MEF25 are lower too, P<0.05.Compare between pre and postoperative pulmonary function,in the postoperative peroid VC、FEV1、PEF have rising trend,not much difference between MEF50、MEF25,but all of them no significant differences were found,P>0.05.3.In the over-6-years-old group, the pre-operative small airway change rate of MSCT is 11/29(37.9%),postoperative is 8/29(27.6%),and no significant difference,P>0.05.The pre-operative pulmonary function find that VC 、 MEF50 are less than the predicted, and the differences are significant,P<0.05. Postoperative tests find that VC、FVC are lower than normal, the differences are significant,P<0.01,FEV1 is lower too, P<0.05. Compare between pre and postoperative pulmonary function,in the postoperative peroid VC、FEV1 show a downward trend,PEF、MEF50 have rising trend, but all of them no significant differences were found,P>0.05.4.In different age groups,with the age rise, the pre-operative small airway change rate of MSCT has rising trend,but no statistical significance,P>0.05.The postoperative small airway change rate of MSCT of the age groups decreased to some extent, but in the over-6-years-old group the descending degree is the least;5.In different degrees of malformation,with the exacerbation of the malformation, the pre-operative small airway change rate of MSCT has rising trend,but no statistical significance,P>0.05.The postoperative small airway change rate of MSCT of the different degrees of malformation groups decreased to some extent, but in the severe group the descending degree is the least.In different degrees of malformation the pre-operative pulmonary function FEV1% 、 PEF% 、 MEF50% and so on haven’t significant differences,P>0.05.The postoperative pulmonary function VC%、FVC% the severe group was smaller than the moderate,FEV1% the severe group was smaller than the mild and the moderate,and the differences were significant,P<0.05.6.There are 21 case in pre-operation period with small airway change of CT,of which 10 children’s pulmonary function totally normal,which accounted for 47.6%(10/21).And in postoperation period there are 9 case with small airway change of CT,of which 3 children’s pulmonary function totally normal,which accounted for 33.3%(3/9).The pre-operative small airway change of MSCT is related with the Haller index positively,the coefficient of rank correlation is equal to 0.456, P<0.01.And it isn’t related to the age、the pre-operative pulmonary function index.The Haller index of the group with pre-operative CT small airway change is higher than the contrast,with significant difference,P<0.05,and the pulmonary function index haven’t statistical differences between two groups,P>0.05.The postoperative small airway change of MSCT is related with the pre-operative age、the pre-operative Haller index and the postoperative Haller index positively.And it isn’t related to all of the postoperative pulmonary function index.The pre-operative Haller index and the postoperative Haller index of the group with postoperative small airway change of MSCT is higher than the contrast,with significant difference, P<0.01,the pre-operative age is higher too,P<0.05,and the pulmonary function index haven’t statistical differences between two groups,P>0.05.Conclusion:1.In the under-3-years-old group, the small airway change rate of CT is from pre-operative 27.3% to postoperative 0%,the recovery of CT is good.On pulmonary function,in the pre-operation this group children have the mild to moderate obstruction of the major and small airways.In the postoperative it still exist mild major airway obstruction.2.In the 3-6-years-old group, the small airway change rate of CT is from pre-operative 33.3% to postoperative 4.8%,decreased significantly,the recovery of CT is good.On pulmonary function,in the pre-operational peroid there are both major and small airway obstructions.Postoperative the major and small airway obstructions are still exist. But as a whole the pulmonary function were improved postoperative.3.In the over-6-years-old group, the small airway change rate of CT is from pre-operative 37.9% to postoperative 27.6%,did not decrease significantly,the recovery of CT is poor. On pulmonary function, in the pre-operational peroid the children have the major and small airway obstructions.Postoperative it still exist the obstructions of the major and small airways. Postoperative most small airways index were showing a tendency to improve,but the major airways index were showing a downward trend.4.In different age groups,with the age rise,the pre-operative small airway change rate of CT rise too;in postoperative period,every age group’s small airway change rate of CT declined,of which children less than 6 years old fallen off obviously,but over 6 years old the falling range was the least.5.In different degrees of malformation groups,the pre-operative pulmonary function have no significant differences,but with the degree of malformation,the pre-operative small airway change rate of CT become higher.In the pre and postoperative period,there are some patients that the pulmonary function test show totally normal,but on CT it prompt the small airway change.There is not obvious correlation between the small airway index of pulmonary function and the small airway change of CT.6.In conclusion,combine the result of MSCT and the pulmonary function test,we suggest the surgery age of PE is less than 6 years old,of which less than 3 years old is the best;MSCT can at an early time and objectively evaluate the small airway change of pectus excavatum.