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О проблеме коррекции деформаций грудной клетки на 23-м конгрессе Европейской Ассоциации Кардио-Торакальных Хирургов


О проблеме коррекции деформаций грудной клетки на 23-м конгрессе Европейской Ассоциации Кардио-Торакальных Хирургов

С 17 по 21 октября в Вене проходил 23 конгресс Европейской Ассоциации Кардио-Торакальных Хирургов. Большое внимание было уделено хирургии грудной стенки и коррекциям врожденных деформаций грудной клетки.

17 октября целых день проходил Техно-Колледж, подготовленный профессором Вильм из Страссбурга. А 19 октября одна из сессий конгресса была полностью посвящена проблеме грудной клетки и деформациям. 

Приводим программу и сообщения по программе без перевода.

Advances in Chest Wall Surgery and Osteosynthesis    
Organisers J.M. Wihlm, Strasbourg, and Domain of Thoracic Disease    
Session 1 Anterior Chest Wall Deformities    
Moderators J. Ribas de Campos, São Paulo; T. Treasure, London    
09:00 Opening remarks/History of techniques and osteosynthesis J.M. Wihlm, Strasbourg   
 Pectus Excavatum    
09:20 Ravitch classical procedure M. Coelho, Curitiba   
09:40 Modified Ravitch techniques S. Elia, Rome   
10:00 Nuss minimally invasive repair J. Ribas de Campos, São Paulo



 Nuss minimally invasive repair


J. Ribas de Campos, São Paulo


 Plates and screws


A. Coonar, Cambridge

10:20 Indications: pro and cons M. Coelho, Curitiba   
10:40 Special cases: mammary hypoplasia, failures, Nuss-Ravitch conversions J.M. Wihlm, Strasbourg   
11:00 Coffee    
11:30 Pectus carinatum and arcuatum P.Y. Brichon, Grenoble   
11:50 Pectus and Marfan syndrome: cardiothoracic strategy J.P. Verhoye, Rennes   
12:10 Panel discussion/conclusions    
12:30 Lunch    
Session 2 Chest Wall Tumours and Reconstruction    
Moderators A. Chapelier, Paris; D. Miller, Atlanta    
13:30 History and principles: the Emory Clinic experience D. Miller, Atlanta   
 Techniques for Reconstruction    
14:00 Soft substitutes: Marlex, Gore-tex, meshes P. Rajesh, Birmingham   
14:20 Stabilisation: methyl-methacrylate C. Spector, Buenos Aires   
14:40 Stabilisation: metallic implants J.M. Wihlm, Strasbourg   
15:00 Myoplasties, omentum, skin flaps C. Spector, Buenos Aires   
 Topographic Indications    
15:20 Sternal and anterior tumours A. Chapelier, Paris   
15:40 Lateral chest wall J. Ribas de Campos, São Paulo   
15:55 Superior and posterior tumours/vascular involvement J.P. Berthet, Montpellier   
16:15 Complex reconstruction cases W. Klepetko, Vienna   
16:30 Coffee    
Session 3 Traumas: Flail Chest    
Moderators D. Lardinois, Basel; J.M. Wihlm, Strasbourg    
17:00 Overview of classical techniques for costal osteosynthesis P.Y. Brichon, Grenoble   
 Renewal of Osteosynthesis    
17:15 Plates and screws A. Coonar, Cambridge   
17:25 Titanium crimped implants D. Lardinois, Basel   
17:35 Rib clips and staples J.M. Wihlm, Strasbourg   
17:45 Presentation of cases/panel discussion P. Moreno, Vigo   
18.00 Adjourn   

А 19 октября одна из сессий конгресса была полностью посвящена проблеме грудной клетки и деформациям.





H.J. Park1, J.Y. Jeong1, W.M. Jo1, J.S. Shin1, I.S. Lee1, K.T. Kim2, Y.H. Choi3             
1Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Ansan Hospital, Republic of Korea; 2Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Seoul, Republic of Korea; 3Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea




 Objectives: Asymmetric pectus excavatum (PE) has not been effectively corrected with the original Nuss technique which used only symmetric bars for all types, without consideration of asymmetry. To cover a wide variety of dysmorphology, we have been shaping the bar in different designs following our novel principle, the "Terrain Contour Matching (TERCOM), a morphology-tailored approach." We propose this bar shaping method for quality repair of asymmetric and adult PE.           
Methods: A single surgeon s (HJP) experience with 1250 consecutive PE repairs between August 1999 and March 2009 was analysed. The bar shaping strictly followed the TERCOM principle; chest wall depression matches the convexity of the bar, and the protrusion matches the concavity – a notch in the bar. To appraise this approach, the Asymmetry Index for post-repair symmetry and Satisfaction Score (1–4, excellent to poor) were assessed.           
Results: The mean age of patients was 10.4 years (16 months–51 years). In repair of 506 (40.5%) asymmetric patients, the asymmetric bar (n=491, 97.0%) for the eccentric type, and the seagull bar (n=238, 47.0%) for the unbalanced type were employed. Bar shaping for adults (age  16 years, n=284, 22.7%) and teenagers was the compound bar (n=276, 22.1%). The Asymmetry Index changed from 1.10 to 1.02 (P<0.001). Satisfaction Score of the eccentric asymmetry was equal to symmetric type (1.08 vs. 1.07, P=0.920) but the unbalanced asymmetry showed a higher score (1.18 vs. 1.07, P=0.005).           
Conclusions: Most of the asymmetric PE could be "quality-repaired" with the morphology-tailored bar shaping (TERCOM) approach, except some misshapen unbalanced asymmetry, which may need a further measure.


A.Z. Khan1, K. Amer1, G. Casali1, R. Wheeler2, D.F. Weeden1   
1Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, UK; 2Wessex Regional Centre for Padiatric Surgery, Southampton General Hospital, Southampton, UK   
Objectives: To compare pectus excavatum correction using VATS-guided Nuss bar placement vs. Ravitch repair.   
Methods: Between 2001 and 2009, 83 patients underwent correction for pectus excavatum: group 1, 16/83, using the Ravitch procedure (vertical midline incision with cartilage cutting and sternal osteotomy); group 2, 67/83, VATS-guided Nuss (convex steel bar inserted under the sternum through 2" bilateral thoracic incisions). One VATS procedure was converted to open. The bar was removed after three years for Nuss and after one year for Ravitch. Statistical analysis was done using SPSS.   
Results: There were significantly more males than females in both groups. Mean age: group 1, 29±11 years, group 2, 17±5.4 years (P<0.0005). Mean hospital stay: group 1, 10±8.5 days, group 2, 6.5±1.3 days (P=0.002). Previous pectus repair: group 1, 3/16, group 2, 1/83 (P=0.003). Wound infection: group 1, 8/16, group 2, 6/67 (P<0.0005). Pain: group 1, 1/16, group 2, 12/83 (P=0.069). Cosmetic approval: Nuss >Ravitch (P=0.005). Regression: group 1, 4/16, group 2, 0/83 (P<0.0005). There was no difference between the groups for other complications, i.e. pneumothorax, chest infection, effusions, and readmissions.   
Conclusions: VATS-guided insertion of the Nuss bar for correction of pectus excavatum is safe and has good cosmetic results compared to Ravitch repair. It is our procedure of choice for primary pectus excavatum up to 25 years of age. Beyond that age, pain is a major issue. VATS facilitates the safe creation of the retrosternal tunnel. 


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