The principles of safe correction and the choice of the method at treatment of Pectus Excavatum at children

Abstract

Purpose: improvement of results of diagnostics and treatment pectus excavatum (PE) at children. Materials and methods. The result of treatment of 113 children aged from 4 to 17 years operated from 2006 to 2017 concerning PE in MRRCI (18 girls and 95 boys) is analysed. Middle age is 12 years. 15 of them were operated in the open way, on Salamaa-Paltiya-9, on Ravich-6. A lot of sequels during and after operation led to refusal of open methods of surgical treatment of PE. Since 2009 to all children operated concerning PE the low-invasive thoracoplasty of Nass procedure was executed. In the preoperative period to 88 patients the multispiral computer tomography with 3D reconstruction is carried out to avoid possible intraoperative complications. Non-standard installation and installation of two CB allows to achieve more physiologic and cosmetic form. Epidural and general anesthesia were used for all patients. The thoracoplasty with use of a video thoracoscopy excludes possible complications, promotes stable and reliable bracing of CB. Use of a sternal elevator for 76 patients proved safety of carrying out CB through a forward mediastinum. Epidural anesthesia and non-steroidal drugs provided optimum anesthesia during the postoperative period. The postoperative period depressed twice and made ≈ 7 days. Results: in a catamnesis of patients from 2 months to 3 years, at 88% from 113 operated the good cosmetic result is received. The total of early complications decreased to 5 that makes 4,4% (a hydrothorax-2, pneumothorax-3). At 3 patients in the late period after operation decubituses in the field of edges of CB are noted that demanded its excision from 1 child. Inputs. Use of a low-invasive thoracoplasty allowed to reduce quantity possible intra-and postoperative complications, achieve the best cosmetic result and reduce hospitalization terms twice.