| Background:Pectus excavatum(PE)is a common congenital thoracic deformity with an incidence of 0.1%-0.3%.The main characteristic of PE is the backward sagged sternum and costicartilages.The deformed sternum will compress heart and lung leading lung capacity decreased and affecting the heart and lung function.The deformed chest wall will cause patient the feeling of inferiority and psychological damaged.There are many procedures to correct PE,including Sternal Elevation Procedure(Ravitch Procedure),Sternal Turnover Procedure and Nuss Procedure.The Nuss procedure has been widely used to correct PE because of its minimal invasion and convenience.In Nuss procedure,the chest deformity is corrected by setting a pectus bar in the retrosternal space and elevating the sternum.Of course,the Nuss procedure has its complications.The main complications include serious complications such as heart injury,lung injury,diaphragmatic muscle injury and bar displacement and general complications of wound infection,pneumothorax and postoperative pain.Though many improvements and innovations have been carried out,the catastrophic complications(such as heart and lung injury)in Nuss procedure have been frequently reported.Therefore,how to improve Nuss procedure,making it more minimally invasive and convenient,reducing the incidence of serious complications,is worth to further study.Objective:The purpose of this study is to discuss how to eliminate catastrophic complications with a finger-guided technique we designed in Nuss procedure,and to analyse its feasibility,convenience and security.We reviewed 76 patients with PE received Nuss operation from January 2012 to December 2015.There are 63 males and 13 females with an average age of 13.3(from 6 to 29).All patients were divided into 2 groups,a finger-guided group(34 cases)and a control group(42 cases).In a finger-guided group,we made a 20-mm skin incision at each anterior-axillary line and the submuscular tunnel was established.A finger was inserted and explored the thoracic cavity and retrosternal tissue,then touched the tip of pectus dissector in the opposite cavity to confirm there was no tissues such as heart or lung between the finger and the tip.Then the pectus dissector was guided by the finger and passed through the retrosternal space.In this way,we can avoid heart and lung injuries without thoracoscopy.The patients in control group were performed by classical Nuss procedure.The perioperative situation,incidence of major complications,hospitalized cost and the postoperative satisfaction in two groups were compared.Results:(1)The procedures were finished in all of the 76 patients.The average operation time in the finger-guided group was significantly less than that in the control group(39.10±10.01 vs 70.15±12.87 min,P=0.028<0.05).(2)The average postoperative hospital stay time in the finger-guided group was significantly less than that in the control group(2.81±0.71 vs 4.01 ±0.81 d,P=0.048<0.05).(3)The total incidence of major complications in the finger-guided group was significantly lower than that in the control group(8.82%vs 26.19%,p=0.041<0.05).(4)There were no significant difference of postoperative satisfaction between two groups(P=0.754>0.05).(5)The average hospitalized cost in the finger-guided group was significantly less than that in the control group(3451 9±2124.12 vs 42240±1520.24,P=0.043<0.05).Conclusion:We designed a novel surgical technique named a finger-guided technique,providing a safe guidance for the pectus dissector to across the retrosternal blind space,attempting to eliminate the catastrophic complications such as heart and lung injuries without thoracoscopy,stabilizers and drainage tubes.The technique is convenient and reliable.It makes the Nuss procedure safer and more minimally invasive and reduces hospitalized cost.It is worth to be popularized and applied. |
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