-What is the pectus excavatum?
Pectus Excavatum/Funnel chest is the sternum, costal cartilage, and some ribs to the dorsal deformity to form a funnel-shaped to form a boat-like or funnel, the vast majority of the sternum of pectus excavatum from the costal cartilage level 2 or 3 of the dorsal to the xiphoid to the lowest pointmalformation, pectus excavatum is a congenital and often familial disease. Inward of the 3-6 costal cartilage of the sternum xiphoid roots (in particular) and their corresponding both sides of the trap, resulting in the shape of the funnel of the anterior chest wall, heart compression shift, pulmonary thoracic deformity and limited range of motion, children with heart and lung function. Children activities, heart palpitations, shortness of breath, often sent the upper respiratory tract and lung infections, and even heart failure. Symptoms by 3 years of age increasingly obvious, concave chest, bulging, thin, poorly developed. Pectus excavatum is often a congenital malformation, involving not only suffering from adverse effects, plot to plot treatment.
Pectus excavatum /Funnel chest- the cause of
The principle of pectus excavatum funnel chest deformity is not yet clear, most people think of pectus excavatum is the costal cartilage and ribs in the development of the lower chest, the growth of excessive squeeze sternum shift compensatory inward depression of the formation of funnel chest. Diaphragm the sternum Ministry of development is too short, so that the sternum compensatory backward shift one of the possible reasons for the formation of funnel chest.
Pectus excavatum/Funnel chest - the pathogenesis of
Younger patients with pectus excavatum deformity is often asymmetrical, gradually asymmetry increase with age, pectus excavatum, the sternum are often rotated to the right side, right side of the costal cartilage of the depression is often worse than the left side of the deep, compared to the left of the right breast development chest side of the poor, mostly flat back or round the back, scoliosis gradually increased with age, infants and young children with scoliosis obvious adolescent scoliosis is more apparent.
Pectus excavatum/Funnel chest - the clinical manifestations
Pectus excavatum more common in men than women and male to female ratio of 4:1, is a sex-linked dominant inheritance more common over the age of 40 under the age of 15 rare, this may be because of severe pectus excavatum and scoliosis oppression of heart and lung, causing breathing and failure of circulatory function, reduced lung capacity, functional residual capacity increased, reduced activity tolerance. Therefore, critically ill patients died before the age of 40; more than 40 years of age in patients with mild to rare visits.
Mild pectus excavatum can be no symptoms, deformity severe oppression of the heart and lungs, affecting the respiratory and circulatory function, young children often recurrent respiratory tract infections, cough, fever, while fewer symptoms of the circulatory system, but the older breathing difficulties can occur after the activity , rapid pulse, palpitations and even chest pain, this is the compression of the heart, cardiac output and to reduce the myocardial ischemia caused. You can also arrhythmias and systolic murmur.
Pectus excavatum sometimes combined with pulmonary hypoplasia with Marfan syndrome, asthma and other diseases often deformity often patients can not tolerate the need for early surgical correction in the combined presence of these diseases.
Pectus excavatum /Funnel chest- treatmentPectus excavatum surgery as long as there is a clear deformity should be surgically. Pseudo pectus excavatum before the age of 3, it may be self-correcting pectus excavatum surgery 3 to 10 years old, the most appropriate age the more light the better the smaller the effect of the extent of surgery; older children surgery often required to remove bone ribs, and often require blood transfusions.1 surgical indications
The indications for surgery are: identified the existence of a constant deformity (ie, infants and young children in forced expiratory clear deformity), funnel chest index> 0.2 combined heart lung function impairment and mental burden heavier.(2) surgical methods
Sternal turnover method, sternum lifting method, fully three categories of chest endoscopic pectus excavatum correction surgery.(1) pectus excavatum sternal turnover operation:① belt vascular pedicled sternal turnover operation: the middle of the thoracic and abdominal skin incision, female patients can be horizontal incision under the breast. Will on both sides of the pectoralis major muscle to the lateral free, revealing the depression of the sternum and on both sides of the ribs and costal deformity, the outer edge of the free rectus abdominis to the umbilical level and along the rectus abdominis, rectus abdominis, in the costal cartilage and the xiphoid attachment points on the need to retain; cut the lower edge of the costal arch, fingers free sternum and both sides of the rib cartilage surface of the pleura until the depression deformity of the lateral, cut off from the deformed costal cartilage on both sides of the beginning part of the 7th rib to the first 3 costal cartilage and intercostal muscle, isolated in the 2nd intercostal space both sides of the thoracic artery and vein to the up and down to free 4 ~ 5cm intercostal artery to avoid electric coagulation. Wire saw this level of cross-sectional sternum sunken sternum and both sides of the rib cartilage is completely free and pectoral plate and costal cartilage with the internal thoracic vein and the rectus abdominis showed a cross state. Attention to protect the thorax and vein is reversed, so as to avoid tearing and intimal thrombosis, the sternum after turning the original most depression to become the most prominent part, can be properly trimmed, so that the sternum to change formation, be taken to avoid damage thoracic blood vessels. Costal cartilage resection is too long when the rampage ends with stainless steel wire suture the sternum, and stitched with polyester thread corresponding to each root rib cartilage fragments and intercostal muscle suture the sternum after the flip costal cartilage plate to a suitable fixed in the original location of fixed closed drainage tube placed in the sternum, and then suturing the pectoralis major muscle, subcutaneous tissue and skin.This spell does not cut off the internal thoracic artery and vein and rectus be able to maintain normal blood circulation of the sternum, to ensure normal growth and development of postoperative sternum, thoracic surgery will arteriovenous full free 4 ~ 5cm length, surgery flip generally do not encounter any difficulties, thoracic artery and vein, and although the rectus abdominis was cruciform cross, but strong arterial pulse, the vein will not stasis. Stable after surgery, chest wall, abnormal breathing, patients with early ambulation deformity to correct the effect of satisfaction. Individual patients after 2 to 3 months after the upper chest transverse sternotomy with mild limitations of depression, some people advocate the use of sternal traction frame traction, you can correct these defects.② with rectus abdominis pedicle sternal turnover technique: This method is to bring the vascular pedicle sternal turnover operation is to this Law, to cut off the internal thoracic artery and vein, leaving only the rectus abdominis muscle pedicle as a source of blood supply. Surgical operation and the former law is basically the same just before ligation to cut off the internal thoracic artery and vein in the transverse sternotomy, then transverse sternotomy, the sternum and rib soft muscle plate with 180 ° of the rectus abdominis pedicle flip after finishing deformation of the sternum suture fixed at the original location.③ sessile pectoral muscle turnover operation with (Wada France): the transverse incision, median sternotomy or bilateral breast free pectoralis major and rectus abdominis revealed deformity of the sternum, costal cartilage and ribs, the hollow from the deformity a little bone side since the costal arch upward in order to cut both sides of the rib cartilage periosteum, cut off the rib cartilage, and costal cartilage and pectoral muscle stripping from the periosteum, in an intercostal space at the sternum downward depression of the transverse sternotomy, complete and be cut off may be attached to part of the intercostal muscle and soft tissue, etc., wash with antibiotic solution, using wire to flip 180 ° sternum fixed at the sternal, costal cartilage to cut off too long, and then use polyester suture fixed parts of the suture in the corresponding ribs muscle and skin.④ sternal turnover and overlap technique: flat chested or depression in some patients, the surgery can flip of the sternum, the breastbone in front of the top of the chamfered shape, insert the front of the periosteum of the sternal part of the pectoral overlapping sternum to move up the overlapping wire sternum suture, stitched with polyester thread costal cartilage costal cartilage of the part of the long overlapping suture, so that postoperative thoracic shape to correct the more satisfied sternal turnover operation is more suitable for adult patients. because the adult sternum elevation technique and so difficult reconstructiveAsymmetry of the funnel chest line sternum reversed turnover operation xiphoid free of the sternum side, began to transform the costal cartilage at the free cut, keeping the blood vessels of the affiliated organizations around the sternum saw to cut off the depression of the sternum, together with the costal cartilage with out; clear sternum cartilage panel of soft tissue and bone plate repair flat upside down back in place, the sternal wire fixed rib cartilage overlapping suture of the Dacron line; Orders placed after drainage of the sternum.(2) sternum lifting method:
Sternum lifting technique also known as the Ravitch orthopedic surgery. Two ribs below the sternum to the full free lift for rampant osteotomy suture since the body wedge-shaped piece of bone embedded in the rear panel of the upper sternum began to sag; the direction of the cut off of the 2 rib cartilage along the former within the outer; both sides of the costal cartilage of the medial side need to overlap with the lateral end of the suture; some scholars in the principles of the the Ravitch orthopedic surgery has been improved, such as the sternum plate cross section, the metal titanium plate to strengthen the fixed and so achieved good effect. Such operations should be noted: For children under the age of 10, sometimes only Sternocostal lifting technique that shortened from 3 to 7 rib resection together to be able to pull up the sunken sternum lift.(3) completely thoracoscopic pectus excavatum correction surgery:Preoperative preparation: generally, there was nothing, pectus excavatum surgery requires general anesthesia, preoperative need to do some routine tests such as the thorax of CT should also look at heart function. Pectus excavatum on cardiopulmonary function of the more serious the more the need for early treatment.Surgical approach: totally thoracoscopic minimally invasive treatment of funnel chest, the chest wall to play 2-3 holes (≈ 1.5cm), do not cut the sternum and ribs. Surgery to adapt to the age range, ranging from 3 years old to 50-year-old patients with pectus excavatum, as well as the traditional surgical treatment failure patients. Surgical wound area reduced significantly reduce the incidence of complications - less invasive; with traditional surgical treatment of pectus excavatum (sternal turnover operation) thoracotomy compared to only 1.5cm around the chest wall incision to reduce the The surgical trauma of the surgery process.
