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Kinder- und Jugendmedizin 2021; 21(03): 168-178
DOI: 10.1055/a-1485-6601
Schwerpunkt

Aktuelle Behandlung der Trichterbrust und Kielbrust

Current treatment of pectus excavatum and carinatum
Peter Zimmermann∗
1   Klinik und Poliklinik für Kinderchirurgie, Universitätsklinikum Leipzig
,
Illya Martynov∗
1   Klinik und Poliklinik für Kinderchirurgie, Universitätsklinikum Leipzig
,
Sebastian Krämer∗
2   Klinik und Poliklinik für Thoraxchirurgie, Universitätsklinikum Leipzig
,
Daniel Gräfe∗
3   Institut für Kinderradiologie, Universitätsklinikum Leipzig
,
Franz Wolfgang Hirsch∗
3   Institut für Kinderradiologie, Universitätsklinikum Leipzig
,
Martin Lacher∗
1   Klinik und Poliklinik für Kinderchirurgie, Universitätsklinikum Leipzig
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ZUSAMMENFASSUNG

Die Trichterbrust ist die häufigste Form der Brustwanddeformitäten. Die Therapieentscheidung erfolgt stets gemeinsam zwischen Patient, den Eltern und dem Chirurgen in wiederholten Gesprächen. Die nicht-invasive Saugglockentherapie stellt für Kinder, welche die Kriterien für eine operative Korrektur nicht erfüllen oder eine chirurgische Therapie ablehnen, eine gute Alternative dar und birgt keine Gefahren. Seit Einführung der minimalinvasiven Trichterbrustkorrektur (MIRPE) hat die Anzahl von Patienten, die eine operative Korrektur Ihrer PE wünschen, deutlich zugenommen. Die Ergebnisse der operativen Korrektur zeigen neben einer hohen Patientenzufriedenheit mit dem kosmetischen Ergebnis auch eine verbesserte Herzleistung und Sauerstoffaufnahmekapazität. Obwohl die MIRPE in erfahrenen Händen sicher und effektiv ist, sind ernsthafte lebensbedrohliche Komplikationen möglich.

Zur Behandlung der Kielbrust ist die nicht-invasive Kompressionstherapie Therapie der Wahl. Dies gilt besonders für die dynamische Kompressionstherapie, welche eine objektive Messung und Einstellung der notwendigen Therapiedrücke, ein laterales Ausweichen der Thoraxwand und individuelle Anpassung ermöglicht. Der Therapieerfolg der Kompressionstherapie liegt „in der Hand des Patienten“. Eine operative Korrektur sollte nur nach nicht erfolgreicher Kompressionstherapie oder bei unbedingtem Patientenwunsch erfolgen.

ABSTRACT

Pectus excavatum (PE) is the most common chest wall deformity. The treatment is based on repeated counselling of the patient and the parents. In children who do not meet the criteria for a surgical approach or refrain from surgery the vacuum-bell is a good option. Since the introduction of minimally invasive repair of pectus excavatum (MIRPE), the number of patients requesting surgical correction has increased significantly. MIRPE leads to a high level of patient satisfaction, improves cardiac output and oxygen uptake capacity. In experienced hands MIRPE is safe and effective; however, serious life-threatening complications are possible.

For pectus carinatum (PC) non-invasive compression therapy (“bracing”) is the treatment of choice. The dynamic compression therapy shows objective measurement and adjustment of the therapeutic pressures, lateral evasion of the thorax wall and individual adjustment which results in excellent outcome. Surgical correction should only be carried out in case of unsuccessful compression therapy.

Schlüsselwörter

Brustwanddeformität - Saugglockentherapie - minimalinvasive Trichterbrustkorrektur - Kompressionstherapie

Keywords

Chest wall deformity - vacuum-bell therapy - minimally invasive repair of pectus excavatum - compression therapy


Publikationsverlauf

Eingereicht: 24. November 2020

Angenommen: 04. Dezember 2020

Artikel online veröffentlicht:
17. Juni 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Cobben JM, Oostra R-J, van Dijk FS. Pectus excavatum and carinatum.. Eur J Med Genet 2014; 57 (08) 414-417
    CrossrefPubMedGoogle Scholar
  • 2 Koumbourlis AC. Pectus excavatum: pathophysiology and clinical characteristics.. Paediatr Respir Rev 2009; 10 (01) 3-6 DOI: 10.1016/j.prrv.2008.12.002. PMID: 19203737
    CrossrefPubMedGoogle Scholar
  • 3 Ashrafian H. Leonardo da Vinci and the first portrayal of pectus excavatum.. Thorax 2013; 68 (11) 1081
    CrossrefPubMedGoogle Scholar
  • 4 Bauhinus J. ObservationumMedicariam. Liber II, Observ. Francfurti.. 1600 Liber II, Observ. 264, Francfurti
    Google Scholar
  • 5 Meyer L. Zur chirurgischen Behandlung der angeborenen Trichterbrust.. Verh Bel Med Gest 1911; 42: 364
    Google Scholar
  • 6 Ravitch MM. The operative treatment of pectus excavatum.. Ann Surg 1949; 129 (04) 429-444
    CrossrefPubMedGoogle Scholar
  • 7 Nuss D, Kelly Jr RE, Croitoru DP. et al A 10-year review of a minimally invasive technique for the correction of pectus excavatum.. J Pediatr Surg 1998; 33 (04) 545-552
    CrossrefPubMedGoogle Scholar
  • 8 Kelly Jr RE. Modifications and Further Development of the Original Nuss Procedure: Blessing or Curse?. Eur J Pediatr Surg 2018; 28 (04) 304-319 DOI: 10.1055/s-0038-1668564. Epub 2018 Sep 13. PMID: 30212922
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 9 Pilegaard HK. Short Nuss bar procedure.. Ann Cardiothorac Surg 2016; 5 (05) 513-518 DOI: 10.21037/acs.2016.09.06. PMID: 27747185; PMCID: PMC5056936
    CrossrefPubMedGoogle Scholar
  • 10 Pilegaard H, Licht PB. Minimal Invasive Repair of Pectus Excavatum and Carinatum.. Thorac Surg Clin 2017; 27 (02) 123-131 DOI: 10.1016/j.thorsurg.2017.01.005. Epub 2017 Mar 1. PMID: 28363366
    CrossrefPubMedGoogle Scholar
  • 11 Obermeyer RJ, Cohen NS, Jaroszewski DE. The physiologic impact of pectus excavatum repair.. Semin Pediatr Surg 2018; 27 (03) 127-132 DOI: 10.1053/j.sempedsurg.2018.05.005. PMID: 30078483
    CrossrefPubMedGoogle Scholar
  • 12 Redlinger Jr RE, Kelly RE, Nuss D. et al Regional chest wall motion dysfunction in patients with pectus excavatum demonstrated via optoelectronic plethysmography.. J Pediatr Surg 2011; 46 (06) 1172-1176
    CrossrefPubMedGoogle Scholar
  • 13 Ewert F, Syed J, Kern S. et al Symptoms in pectus deformities: a scoring system for subjective physical complaints.. Thorac Cardiovasc Surg 2017; 65 (01) 43-49
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 14 Sujka JA, St Peter SD. Quantification of pectus excavatum: Anatomic indices.. Semin Pediatr Surg 2018; 27 (03) 122-126 DOI: 10.1053/j.sempedsurg.2018.05.006. Epub 2018 May 16. PMID: 30078482
    CrossrefPubMedGoogle Scholar
  • 15 St Peter SD, Juang D, Garey CL. et al A novel measure for pectus excavatum: the correction index.. J Pediatr Surg 2011; 46 (12) 2270-2273 DOI: 10.1016/j.jpedsurg.2011.09.009.
    CrossrefPubMedGoogle Scholar
  • 16 Obermeyer RJ, Gaffar S, Kelly Jr RE. et al Selective versus routine patch metal allergy testing to select bar material for the Nuss procedure in 932 patients over 10 years.. J Pediatr Surg 2018; 53 (02) 260-264 DOI: 10.1016/j.jpedsurg.2017.11.021. Epub 2017 Nov 14. PMID: 29223667
    CrossrefPubMedGoogle Scholar
  • 17 Sakamoto K, Ando K, Noma D. Metal allergy to titanium bars after the Nuss procedure for pectus excavatum.. Ann Thorac Surg 2014; 98: 708-710
    CrossrefPubMedGoogle Scholar
  • 18 Haecker FM, Sesia S. Vacuum bell therapy.. Ann Cardiothorac Surg 2016; 5: 440-449
    CrossrefPubMedGoogle Scholar
  • 19 Schier F, Bahr M, Klobe E. The vacuum chest wall lifter: an innovative, nonsurgical addition to the management of pectus excavatum.. J Pediatr Surg 2005; 40: 496-500
    CrossrefPubMedGoogle Scholar
  • 20 Obermeyer RJ, Cohen NS, Kelly RE. et al Non-operative management of pectus excavatum with vacuum bell therapy: A single-center study.. J Pediatr Surg 2018; 53 (06) 1221-1225
    CrossrefPubMedGoogle Scholar
  • 21 St-Louis E, Miao J, Emil S. et al Vacuum bell treatment of pectus excavatum: An early North American experience.. J Pediatr Surg 2019; 54 (01) 194-199 DOI: 10.1016/j.jpedsurg.2018.10.011. Epub 2018 Oct 5. PMID: 30414687
    CrossrefPubMedGoogle Scholar
  • 22 Kelly RE, Goretsky MJ, Obermeyer R. et al Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients.. Ann Surg 2010; 252 (06) 1072-1081
    CrossrefPubMedGoogle Scholar
  • 23 Frantz FW. Indications and guidelines for pectus excavatum repair.. Curr Op Ped 2011; 23: 486-491
    CrossrefPubMedGoogle Scholar
  • 24 Jacobsen EB, Thastum M, Jeppesen JH. et al Health-related quality of life in children and adolescents undergoing surgery for pectus excavatum.. Eur J Pediatr Surg 2010; 20: 85-91
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 25 Park HJ, Sung SW, Park JK. et al How early can we repair pectus excavatum: the earlier the better?. Eur J Cardiothorac Surg 2012; 42: 667-672
    CrossrefPubMedGoogle Scholar
  • 26 Pilegaard HK. Extending the use of Nuss procedure in patients older than 30 years.. Eur J Cardiothorac Surg 2011; 40: 334-338
    PubMedGoogle Scholar
  • 27 Pilegaard HK. Nuss technique in pectus excavatum: a mono-institutional experience.. J Thorac Dis 2015; 7 (Suppl. 02) 172-176
    PubMedGoogle Scholar
  • 28 Kelly Jr RE, Obermeyer RJ, Goretsky MJ. et al Recent Modifications of the Nuss Procedure: The Pursuit of Safety During the Minimally Invasive Repair of Pectus Excavatum. Ann Surg 2020 Mar 27. DOI: 10.1097/SLA.0000000000003877 Epub ahead of print. PMID: 32224740
    CrossrefPubMedGoogle Scholar
  • 29 Hebra A. Minor and Major Complications Related to Minimally Invasive Repair of Pectus Excavatum.. Eur J Pediatr Surg 2018; 28: 320-326 DOI: 10.1055/s-0038-1670690. Epub 2018 Sep 18. PMID: 30227447
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 30 Park HJ, Jeong JY, Jo WM. et al Minimally invasive repair of pectus excavatum: a novel morphology-tailored, patient-specific approach.. J Thorac Cardiovasc Surg 2010; 139 (02) 379-386
    CrossrefPubMedGoogle Scholar
  • 31 Maagaard M, Tang M, Ringgaard S. et al Normalized cardiopulmonary exercise function in patientswith pectus excavatum three years after operation.. Ann Thorac Surg 2013; 96 (01) 272-278
    CrossrefPubMedGoogle Scholar
  • 32 Emil S. Current Options for the Treatment of Pectus Carinatum: When to Brace and When to Operate?. Eur J Pediatr Surg 2018; 28 (04) 347-354 DOI: 10.1055/s-0038-1667297. Epub 2018 Aug 15. PMID: 30112746
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 33 Koumbourlis AC. Pectus deformities and their impact on pulmonary physiology.. Paediatr Respir Rev 2015; 16 (01) 18-24
    PubMedGoogle Scholar
  • 34 Martinez-Ferro M, Fraire C, Bernard S. Dynamic compression system for the correction of pectus carinatum.. Semin Pediatr Surg 2008; 17 (03) 194-200
    CrossrefPubMedGoogle Scholar
  • 35 Knudsen MV, Grosen K, Pilegaard HK, Laustsen S. Surgical correction of pectus carinatum improves perceived body image, mental health and self-esteem.. J Pediatr Surg 2015; 50 (09) 1472-1476
    CrossrefPubMedGoogle Scholar
  • 36 Muntean A, Stoica I, Saxena AK. Pigeon chest: comparative analysis of surgical techniques in minimal access repair of pectus carinatum (MARPC).. World J Pediatr 2018; 14 (01) 18-25 DOI: 10.1007/s12519-018-0121-2. Epub 2018 Mar 2. PMID: 29500788
    CrossrefPubMedGoogle Scholar
  • 37 Vidal J, Perdriolle R, Brahin B. et al Conservative treatment of deformities of the anterior chest wall [in French].. Rev Chir Orthop Repar Appar Mot 1977; 63 (06) 595-608
    Google Scholar
  • 38 Martinez-Ferro M, Bellia Munzon G, Fraire C. et al Non-surgical treatment of pectus carinatum with the FMF® Dynamic Compressor System.. J Vis Surg 2016; 2: 57
    CrossrefPubMedGoogle Scholar
  • 39 Sesia SB, Holland-Cunz S, Häcker FM. Dynamic compression system: an effective nonoperative treatment for pectus carinatum: a single center experience in Basel, Switzerland.. Eur J Pediatr Surg 2016; 26 (06) 481-486
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 40 Emil S, Sévigny M, Montpetit K. et al Success and duration of dynamic bracing for pectus carinatum: a four-year prospective study.. J Pediatr Surg 2017; 52 (01) 124-129
    CrossrefPubMedGoogle Scholar
  • 41 Abramson H, D’Agostino J, Wuscovi S. A 5-year experience with a minimally invasive technique for pectus carinatum repair.. J Pediatr Surg 2009; 44 (01) 118-123 discussion 123–124 10.1016/j.jpedsurg.2008.10.020 PMID: 19159728
    CrossrefPubMedGoogle Scholar
  • 42 Del Frari B, Sigl S, Schwabegger AH. Complications related to pectus carinatum correction: lessons learned from 15 years’ experience. Management and literature review.. Plast Reconstr Surg 2016; 138 (02) 317e-329e
    CrossrefPubMedGoogle Scholar