Berkant ÖZPOLAT, Ali SARIGÜL, M. F. Tolga SOYAL, Gökhan GÖKASLAN, Tulu TOPHANELİOĞLU, Ertan YÜCEL

Pektus ekskavatum ve karinatum deformitelerinin cerrahi düzeltilmesi: 30 olgunun değerlendirilmesi

Amaç: Cerrahi tedaviyle düzeltilen pektus ekskavatum ve karinatum deformiteli olguların sonuçları değerlendirildi. Çalışma planı: 2000-2004 yılları arasında, pektus ekskavatum ve pektus karinatum nedeniyle cerrahi düzeltme yapılan ardışık 30 hasta (21 erkek, 9 kadın; ort. yaş 15.1±3.4; dağılım 5-20) geriye dönük olarak incelendi. On dokuz hastada (%63.3) karinatum, 11 hastada (%36.7) ekskavatum deformitesi vardı. En sık semptom nefes darlığıydı (17 hasta, %56.7). Altı hastada (%20) elektrokardiyografide nonspesifik T ve ST değişiklikleri saptandı. Ekokardiyografide 10 hastada (%33.3) mitral kapak prolapsusu görüldü. Bir hastada ileri derece olmak üzere, üç hastada (%10.3) skolyoz vardı. Tüm hastalarda cerrahi teknik olarak modifiye Ravitch onarımı kullanıldı. Ortalama takip süresi 12±3 ay idi. Bulgular: Hastanede yatış süresi dört günle 21 gün arasında değişmekteydi (pektus karinatumlu olgularda ortalama 4.8±1.4 gün, ekskavatumlu olgularda 9.8±4.9 gün). Ameliyat sonrasında bir hastada (%3.3) yara yeri enfeksiyonu, bir hastada pnömotoraks gelişti; bir hastada 24 saat süren aralıklı taşikardi atakları görüldü. Tüm hastaların ameliyattan tamamen memnun oldukları görüldü. Ameliyat sonrası dönemde geç komplikasyon olarak altıncı ayda bir hastada deformitenin orta derecede tekrarladığı gözlendi. Sonuç: Pektus ekskavatum ve karinatum deformitelerinde modifiye Ravitch tekniği ile sternuma normal pozisyonu verilmiş ve anterior göğüs duvarının normal görünümü sağlanmıştır. Düşük morbiditesi, ameliyat sonrası hastanede kalış süresinin kısa olması, düşük maliyeti ve yüksek hasta tatmini bu tekniğin önemli avantajlarıdır.

Surgical correction of pectus excavatum and carinatum deformities: Evaluation of 30 cases

Background: We evaluated the results of surgical correction in patients with pectus excavatum and carinatum deformities. Methods: Between 2000 and 2004, 30 patients (21 males, 9 females; mean age 15.1±3.4 years; range 5 to 20 years) underwent surgical correction for pectus excavatum and carinatum deformities. Nineteen patients (63.3%) had a carinatum, 11 patients (36.7%) had an excavatum deformity. The most common symptom was shortness of breath in 17 patients (56.7%). Six patients (20%) had nonspecific T- and ST-wave changes on electrocardiography and 10 patients (33.3%) had mitral valve prolapse on echocardiography. Scoliosis was present in three patients (10.3%), one of which was severe. Surgical repair was performed with a modified Ravitch procedure in all the patients. The mean follow-up period was 12±3 months. Results: The length of hospital stay ranged from four to 21 days, with a mean of 4.8±1.4 days and 9.8±4.9 days for carinatum and excavatum deformities, respectively. Early postoperative complications were wound infection in one patient and pneumothorax in another. One patient experienced intermittent attacks of tachycardia for postoperative 24 hours. All the patients were completely satisfied with the operation. The deformity recurred to a moderate degree in one patient in the postoperative sixth month. Conclusion: The modified Ravitch procedure provided a normal sternal position and a normal appearance of the anterior thoracic wall in patients with pectus excavatum and carinatum deformities, with low morbidity, short postoperative hospital stay, cost-effectiveness, and high patient satisfaction.

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