Pektus ekskavatumda Nuss tekniğinin farklı yaş gruplarında klinik sonuçları

Amaç: 1998 yılında Donald Nuss minimal invaziv teknik olarak pektus ekskavatumda sternum arkasına metal bar yerleştirilmesini önermiştir. Bununla beraber hastaların yaşları ve klinik sonuçları ile ilgili veriler sınırlıdır. Bu çalışmanın amacı, farklı yaş grupları arasında pektus ekskavatumda Nuss cerrahisinin klinik sonuçlarını karşılaştırmak, bu prosedür için en uygun yaş aralığını vurgulamaktır. Gereç ve Yöntemler: Şubat 2012 ile Ocak 2020 yılları arasında Nuss operasyonu ile tedavi edilen 140 olgu çalışmaya alındı. Olgular 3 grup olarak sınıfandırıldı: 15 yaşından küçük olgular (grup A), 15-20 yaş aralığında olanlar (grup B), 20 yaşından büyük 40 yaşa kadar (grup C) olarak sıralandı. Hastaların, demografik yapıları, cerrahi sonuçları, hastanede yatış süreleri ve komplikasyon oranları değerlendirilerek karşılaştırıldı. Bulgular: Yüz on hasta erkek, 30 hasta kadındı. Erkek olgular, solunum sıkıntısı klinik şikayeti olan olgular en sık ileri yaş grubunda görüldü ve istatistiksel olarak anlamlı idi (p:0.003). Erken postoperatif 30 gün ölüm izlenmedi. En sık komplikasyon grup C (%40,9), takiben grup B (%18,2) ve grup A (%9,7) görüldü (p:0.007). Lojistik regresyon analizinde 20 yaş üstü olan olgularda postoperatif komplikasyonlar anlamlı olarak yüksek bulundu (p:0.003). Ergenlik döneminde bar çıkarılması sonrası nüks gelişen 2 grup A olgusuna Brace tedavisi uygulandı. Sonuç: Nuss tekniği, düşük komplikasyon oranı, kısa süreli hastanede yatış ve tatminkar sonuçları ile tavsiye edilebilir. Çocukluk dönemi, komplikasyonlara bağlı uygun gibi görülmesine rağmen cerrahi, nüks oranı düşüklüğü nedeniyle ergenlik döneminde tercih edilebilir.

Anahtar Kelimeler:

Nuss tekniği, Pektus ekskavatum, Minimal invaziv onarım pektus cerrahisi

Clinical results of Nuss procedure for pectus excavatum in different age groups

Aim: In 1998, Donald Nuss suggested the insertion of a metal bar behind the sternum for pectus excavatum as a minimally invasive technique. However, data regarding the relation between the age of the patient and clinical results of repair is limited. Aim of this study is to compare the clinical results of Nuss surgery for pectus excavatum in different age groups, to point out the optimal range of age for this procedure. Material and Methods: From February 2012 to January 2020, data regarding 140 patients have been treated with Nuss surgery. We classified patients into three groups: patients younger than 15 years (group A), patients between 15 and 20 years (group B); and patients older than 20 years up to 40 years (group C) retrospectively. We evaluated patients' demographics, and compared results of surgery, duration of hospitalization and complication rates. Results: One hundred ten patients were male and 30 were female. Male patients, clinical symptomatic patients with dyspnea in the preoperative period were seen more frequently in patients with older age, and each were statistically significant (p:0.003). In the early 30-day postoperative period, no mortality was observed. The most frequent postoperative complications were observed in group C (40,9%), followed by group B (18,2%) and group A (9,6%)(p:0.007). In logistic regression analysis, postoperative complications increased significantly in patients older than 20 years (p:0.003). Brace therapy was performed for 2 cases in Group A for recurrence after bar removal which occurred in adolescant period. Conclusion: Nuss procedure can be recommended with low complication rates, short term hospitalization and high grade of success. Although the childhood period seems to be more suitable regarding the complications, surgery can be preferred with low recurrence rates in adolescant period.

Keywords:

Nuss Procedure, Pectus Excavatum, Minimally Invasive Repair of Pectus Excavatum,

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