應醫學雜誌之邀稿, 謹對漏斗胸治療的演進做一介紹，供病友們參考。在台灣, 漏斗胸的治療已如先進國家, 早進入了微創手術時代, 但仍有大部分的病友並不熟悉, 而錯失了治療機會.
Mini Review
A Look at the History of Surgery for Pectus Excavatum
Chih-Chun Chu (朱志純)
Formos J Surg 2011;44:1-5
Pectus excavatum is the most common deformity of the anterior wall of the chest, in which several ribs,costal cartilages and the sternum grow abnormally and produces a caved-in appearance of the chest. PE is usually considered to be cosmetic; however, depending on its severity, the deformed chest wall can compress the heart and reduce the thoracic volume, and impair cardiac and respiratory function, distort spine curvature, and cause pain in the chest.
A review of the literature shows that the first record of pectus excavatum was probably written in the 16th century by Johan Schenck (1531-1590). Bauhinus (1594)1 described a case in which the patient suffered from shortness of breath and cough as a result of severe pectus excavatum. In 1820, Coulson2 cited a family including three brothers with a funnel chest. In 1872, Williams3 reported a patient born with a pectus excavatum whose father and a brother also suffered from the same condition. Ever since, the reported cases have gradually increased, but treatment before the 20th century was limited to fresh air, breathing exercises and lateral pressure on the chest, all of which probably exerted no substantial beneficial effect. During those early days, technology of surgery and anesthesia was unable to overcome lung collapse during thoracic surgery, and the progress in treatment of pectus excavatum remained stagnant until early 20th century. Meyer in 19114 removed the first, second and third costal cartilages of a patient with pectus excavatum, but apparently did not attained the desired effect. Sauerbruch in 1931,5 performed surgery on a patient with pectus excavatum suffering from severe dyspnea in a negative pressure chamber wherein he removed a part of the anterior chest wall which included the fifth to the ninth costal cartilages, as well as a segment of the adjacent sternum. After the procedure, the patient was able to work, and even married three years later. It is difficult to imagine how science and technology at the time was able to complete such a type of operation. In the 1920’s, he had already advocated bilateral removal of costal cartilages and sternum transection in order to raise the anterior chest wall. After the procedure, according to Sauerbruch the patient had to stay in bed for external traction to hold the anterior chest wall in position for 6 weeks or more. Although the process was very harmful, the technology provided a method of treatment that had not been achieved before, and it soon gained popularity in Europe and the United States.
