Clinecal Investigation and Acute Complications of Remodelling Plasty of Costochondral Rib Cage For Pectus Excavatum

전흉벽 늑연골의 리모델링 성형술을 이용한 누두흉수술의 임상적 고찰 초기합병증

  • Her, Keun (Dept. of Thoracic & cardiovascular Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Song, Cheol-Min (Dept. of Thoracic & cardiovascular Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Jeon, Cheol-Woo (Dept. of Thoracic & cardiovascular Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Jang, Won-Ho (Dept. of Thoracic & cardiovascular Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Kim, Hyun-Jo (Dept. of Thoracic & cardiovascular Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Jeong, Yoon-Seop (Dept. of Thoracic & cardiovascular Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Youm, Wook (Dept. of Thoracic & cardiovascular Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine)
  • 허균 (순천향대학교의과대학부속 흉부외과) ;
  • 송철민 (순천향대학교의과대학부속 흉부외과) ;
  • 전철우 (순천향대학교의과대학부속 흉부외과) ;
  • 장원호 (순천향대학교의과대학부속 흉부외과) ;
  • 김현조 (순천향대학교의과대학부속 흉부외과) ;
  • 정윤섭 (순천향대학교의과대학부속 흉부외과) ;
  • 염욱 (순천향대학교의과대학부속 흉부외과)
  • Published : 2002.12.01

Abstract

Acute Complications of Remodelling Plasty of Costochondral Rib Cage For Pectus excavatum Recently, Remodelling Plasty of Costochondral Rib Cage has been introduced as an minimally invasive procedure and expanded its application for pectus excavatum. Outcomes and acute complications were reviewed Material and Method: A retrospective survey of 55 patients who underwent Remodelling Plasty of Costochondral Rib Cage from September, 1999 to February, 2002 was conducted to review complications, postoperative treatments, and outcomes. Result: Age ranged from 1 to 27 years(mean 11.4 $\pm$ 7.1). 35(64%) were less than 15-year old and 20(36%) were more than 15-year old. There were 44(80%) Male patients and 11(20%) female patients. Length of hospital stay was 7.8 $\pm$ 2.1 days for less than 15-Y-old group, 10.6 $\pm$ 6.2 days for more than 15-Y-old group(p = 0.042) One substernal bar was inserted in 52 patients and two substernal bars were inserted in 3 patients. As for stabilizer, one lateral side was fastened in 15 patients and both lateral sides were fastened in 6 patients. In the less than 15-Y-old group, 4 patients needed stabilizer, whereas in the more than 15-Y-old group, 18 patients needed stebilizer(s)(p = 0.000). Including all kinds of complications, 28(51 %)patients had postoperative complications. Of them, only 7 patients were treated for complications(C-tube insertion was done in 7 patients and reoperation for bar refixation or removal was done in 3 patients of them). Conclusion: Most complications after Remodelling Plasty of Costochondral Rib Cage For Pectus Excavatum were trivial without treatment although C-tube drainage was needed in some patients. However bar displacement such as rotation and lateral sliding should be corrected as soon as detected in order not to remove the bar(the worst situation).

누두흉 환자에 대해 최소침습적 방법으로 전흉벽 늑연골의 리모델링 성형술이 선호되고 있다. 본원에서 시행한 누두흉 환자들을 대상으로 늑연골의 리모델링 성형술의 시행시 발생할 수 있는 초기 합병증의 종류와 이에 대한 치료법의 연구이다. 대상 및 방법: 본원에서 1999년 9월에서부터 2002년 2월까지 오목가슴으로 인해 늑연골의 리모델링 성형술을 시행받은 55명을 대상으로 의무기록을 중심으로 후향적 분석을 시행하였다. 입원기간, 수술 후 관리, 수술 후 한 달 내에 발생한 합병증과 치료 방법 등을 분석하였다. 결과: 입원일은 5일에서 29일(8.6$\pm$4.2일)이었고 특별한 합병증이 없어도 퇴원하는 날까지 단순흥부촬영을 매일 시행하였으며 55명중 수술 후 합병증이 발생한 환자는 28명(51%)이었으며 기흉이 11명(20%), 혈흉이 6명(11%), 혈기흉이 3명(5%)이었으며 그 외 폐렴 및 무기폐등이 발생하였고 이중 3명(3%)은 상기 합병증과 더불어 철심의 변위 및 상처감염이 발생하였다. 28명의 합병증이 발생한 환자들 중 흉관삽입술이나 치료가 필요했던 환자들은 7명(13%)이었다. 결론: 늑연골의 리모델링 성형술후에 발생하는 합병증과 그의 치료에 대해 대부분의 환자들에서는 특별한 치료가 필요하지 않았으나 좀더 오랜 기간 추적관찰이 필요하다.

Keywords

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