| Abstract | Cilj istraživanja: Pristup liječenju ljevkastih prsiju može biti konzervativan ili kirurški. Cilj ovog istraživanja je bio utvrditi čimbenike koji utječu na ishod liječenja te same ishode liječenja ljevkastih prsiju minimalno invazivnom metodom po Nuss-u.
Ispitanici i metode: Od 1. siječnja 2014. do 31. prosinca 2020. godine, 30 bolesnika uključeni su u ovu studiju. Retrospektivno su prikupljeni demografski podaci bolesnika (dob, spol, tjelesna visina, tjelesna masa, BMI, CT Haller indeks), ishodi liječenja (trajanje operacije, duljina hospitalizacije, intraoperacijske komplikacije, rane i kasne komplikacije, poslijeoperacijska analgezija) te su isti kontaktirani minimalno dvije godine nakon zahvata kako bi se zabilježilo subjektivno zadovoljstvo ishodom te korištenje analgezije kod kuće.
Rezultati: Od 30 bolesnika bilo je 22 ispitanika muškog spola i 8 ispitanica ženskog spola. Prosječna dob bila je 15 godina, a prosječni ITM je iznosio 18,5 kg/m² za muški spol te 18,2 kg/m² za ženski spol. Prosječan CT Haller indeks bio je 3,67 za muški spol te 3,69 za ženski spol. Prosječno trajanje operacije bilo je 120 minuta, a duljina hospitalizacije 8,5 dana. Uspjeh u korekciji deformiteta iznosio je 93,1%. Indikacije za operaciju bile su psihološke prirode (47%), zatim respiracijske smetnje (30%) te kombinirane respiracijsko - kardijalne (20%) i respiracijsko - psihološke smetnje (3%). Rane komplikacije uočene su u 18 bolesnika (60%), a kasne u 7 bolesnika (23,3%). Intraoperacijske nisu zabilježene. Najčešće rane komplikacije bile su pneumotoraks (30%) i emfizem (30%), dok su kasne pomak ploče (10%) i recidiv (6,7%). Prilikom dolaska kući 22 bolesnika koristilo je analgetike najmanje jedan dan, a najviše do šest mjeseci, dok njih 5 analgetike uopće nije koristilo. Odličan rezultat operacijskog postupka (ocjena 5) komuniciralo je 23 bolesnika, dok je četvero navelo dobar rezultat (ocjena 4). Samo po jedan bolesnik naveo je osrednji i loš rezultat (ocjena 2 i 3).
Zaključci: Postupak po Nuss-u je sigurna te učinkovita metoda za liječenje ljevkastih prsiju u djece i adolescenata. Ujedno daje izvrsne kozmetičke i estetske rezultate te jako dobro subjektivno zadovoljstvo ishodom operacijskog liječenja. |
| Abstract (english) | Objectives: The approach to treating funnel chest can be conservative or surgical. The aim of this study was to determine the factors influencing the treatment outcome and the outcomes of the treatment of funnel chest by the minimally invasive Nuss method.
Patients and methods: From January 1st 2014 until December 31st 2020, 30 patients were included in this study. The patient's demographics data (age, sex, height, weight, BMI, CT Haller index), treatment outcomes (duration of surgery, length of hospitalization, intraoperative complications, early and late complications, postoperative analgesia) were monitored and contacted for a minimum two years after the procedure to record subjective satisfaction with the outcome and use of analgesia.
Results: Out of the 30 patients included in this study, 22 were male and 8 were female. The median age was 15 years, and the median BMI was 18.5 kg/m² for male and 18.2 kg/m² for female. The median CT Haller index was 3.67 for male and 3.69 for female. The median duration of surgery was 120 minutes and the median length of hospitalization was 8.5 days. In 93.1% of the patients deformity was succesfully corrected. Indications for surgery were psychological (47%), followed by respiratory disorders (30%) and combined respiratory-cardiac (20%) and respiratory-psychological disorders (3%). Early complications were observed in 18 patients (60%) and late in 7 patients (23.3%). Intraoperative were not reported. The most common early complications were pneumothorax (30%) and emphysema (30%), while late bar displacement (10%) and recurrence of deformity (6.7%). Upon arrival home, 22 patients used analgesics for at least one day, up to a maximum of six months, while 5 did not use them. An excellent result of the surgical procedure (grade 5) was communicated by 23 patients. 4 of them have a good result (grade 4), and one mediocre and one bad result (grade 2 and 3).
Conclusion: The Nuss procedure is a safe and effective method for treating funnel chest in children and adolescents. It also gives excellent cosmetic and aesthetic results and very good subjective satisfaction with the outcome of surgical treatment. |
