台灣漏斗胸(凹胸)病友協會

Improvement of Growth Development Curve in Nuss procedure for Pediatric Pectus Excavatum

兒童漏斗胸在納氏手術後生長曲線的改進

I. Background/Purpose

發現在兒童漏斗胸以納氏手術治療後, 在其生長曲線上, 不論身高及體重都有顯的增進. <br>

In treating pediatric pectus excavatum patients with the Nuss procedure, we found that there were improvements in body weight (BW) and body height (BH) in the growth curve of these children. Herein, we want to describe improvements in the growth curve in pediatric patients who underwent the Nuss procedure for pectus excavatum.  

II. Patients and Methods <br>
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116 children aged 3 to 17 with pectus excavatum received the Nuss procedure between June 2005 and September 2009. Indications for surgery included two or more of the following: progression of deformity; exercise intolerance or restrictive disease on pulmonary function test; Haller index > 3.25; mitral valve prolapse; or heart compression. All surgeries were performed in a uniform manner by the same pediatric surgeon. Height and weight data for all subjects were collected 1 day before surgery (OP); 6 months postoperatively (6M) and 1 year postoperatively (1Y) and compared with the pediatric development chart. Exclusionary criteria included: age above 14 years prior to surgery; previous thoracic surgery; absence of complete data for weight and height within 1 year; and rank below the lowest (< 3%) or above the highest (> 97%) percentiles on the pediatric development chart. <br>




III. Results<br>

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A total of 116 pediatric patients with pectus excavatum received the Nuss procedure in our hospital; 30 were included in this study. The average BW (average growth development percentile) at OP, 6M, and 1Y were 27.97 kg (49.17%), 30.67 kg (57.42%), and 32.19 kg (60.42%) respectively. The average BH (average growth development percentile) at OP, 6M, and 1Y were 130.15 cm (57.25%), 130.68 cm (61.84%), and 137.33 cm (65.32%) respectively. Compared with the OP and the 6M and with the OP and 1Y in the BW growth development percentile, the P values were 0.01 and < 0.01. In comparison with the OP and the 6M and the OP and 1Y in the BH growth development percentile, the P values were 0.02 and < 0.01. Both differences were significant. IV. Discussion The Nuss procedure [1] is the most revolutionary method for treating patients with pectus excavatum [2, 3]. This minimally invasive procedure corrects the pectus excavatum physically instead of destructing the costo-cartilage structure. The improvement in BH may be due to the correction of the deformity and directing it to a relative normal thoracic structure while improvement in BW may possibly be due to the decrease the cardiopulmonary compression and decrease in the respiratory effort of the body.

Conclusion:

Pectus excavatum in pediatric patients can be treated safely and successfully by using the Nuss procedure. The procedure also has the benefit of improvement of the growth development curve in pediatric patients who were preoperatively in the normal or lower growth percentile in the growth development chart. Fig. 1 The average growth development percentile in BW at OP, 6M and 1Y. (** p<0.01) Fig. 2 The average growth development percentile in BH at OP, 6M and 1Y. (* p<0.05, ** p<0.01)

兒童漏斗胸可相當安全及成功地用納氐手術治療.  這手術方法也對兒童病患的生長有明顯的幫助.