• Journal of Chest Surgery
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• 제41권6호
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• pp.742-746
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• 2008

배경: 새가슴의 수술적 치료는 완전한 늑연골의 절제와 흉골의 쐐기 골절술을 하는 변형된 라비치 술식을 주로 사용한다. 저자들은 수술을 간편하고 쉽게 하고자 변형된 튀어나온 늑연골만을 절제하고 흉골의 골절술없이 스테인레스 금속막대로 튀어나온 흉골을 앞에서 눌러 압박하는 방식으로 수술을 하였다. 이러한 방식으로 수술한 환자들을 대상으로 수술의 유용성과 효과 등을 평가하고자 본 연구를 시행하였다. 대상 및 방법: 2006년 7월부터 2008년 6월까지 새가슴으로 본원에서 부분 늑연골 절제와 스테인레스 금속막대를 이용한 흉골 압박 수술을 시행 받은 환자들 10명을 대상으로 진행을 하였다. 수술의 효과와 합병증 등을 관찰하였다. 결과: 새가슴만 단독으로 수술 받은 환자가 5명, 새가슴과 오목가슴이 같이 복합으로 존재하여 새가슴 수술과 오목가슴의 너스 수술을 같이 시행 받은 환자가 5명이었다. 환자들의 평균 연령은 13.4+3.3세였다. 평균 수술기간은 새가슴 단독 수술만 시행된 경우가 137.6+22.9분이었고 새가슴과 오목가슴이 공존하여 같이 수술을 받은 경우는 234.0+36.5분이었다. 평균 입원기간은 11.8+1.0일이었다. 새가슴의 술전 Halter's pectus index는 $2.10{\pm}0.21$에서 수술 후에는 $2.53{\pm}0.07$로 증가하였다. 합병증으로는 단순한 부분적인 창상균열이 1예 있었다. 결론: 저자들은 10명의 새가슴 환자들에게 변형된 튀어나온 늑연골만을 절제하고 흉골의 골절술 없이 스테인리스 금속막대로 튀어나온 흉골을 앞에서 눌러 압박하는 수술을 시행하여 좋은 결과를 얻었다. 이러한 저자들의 치료법은 기존의 라비치 수술법에 비하여 쉽고 간편한 수술법이다. 그러나 아직 금속막대의 제거가 모든 환자에서 완전히 이루어진 상태가 아니므로 정확한 치료효과에 관하여서는 좀 더 많은 수술례를 대상으로 장기적인 추적 관찰이 필요하다.

• Journal of Chest Surgery
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• 제32권5호
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• pp.489-493
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• 1999

새가슴은 흉골이 전방으로 돌출 되는 흉벽 기형의 하나로 전방 흉벽이 함몰되는 누두흉보다 그 빈도가 훨씬 적다. 남자에게서 흔하며, 척추 측만증(scoliosis)을 가장 많이 동반한다. 새가슴의 수술적 교정 \ulcorner1952년 Ravitch가 연골흉골병형(chondromanubrial type)에서 다발 기형 늑골 절제와 이중 골 절단술을 처음으로 시행하였다. 저자들은 출생 시부터 관찰되어 성장에 따라 심해진 비대칭성 새가슴 환자 1례에서 양측 기형 늑연골의 연골막하 부분 절제술과 흉골의 단일 골 절단술을 시행하였다. 술후 합병증은 없었으며, 만족할만한 결과를 얻었기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제49권2호
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• pp.92-98
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• 2016

Background: We used an Abramson technique for minimally invasive repair of pectus carinatum in patients who preferred surgery to brace therapy, had been unsuccessfully treated via brace therapy, or were unsuitable for brace therapy because of a rigid chest wall. Methods: Between July 2011 and May 2015, 16 patients with pectus carinatum underwent minimally invasive surgery. Results: The mean age of the patients was $24.35{\pm}13.20years$ (range, 14-57 years), and all patients were male. The percentage of excellent aesthetic results, as rated by the patients, was 37.5%, and the percentage of good results was 56.25%. The preoperative and postoperative Haller Index values were $2.01{\pm}0.19$ (range, 1.60-2.31), and $2.22{\pm}0.19$ (range, 1.87-2.50), respectively (p-value=0.01), and the median hospital stay was $7.09{\pm}2.91days$ (range, 5-15 days). Only one patient experienced postoperative complications. Conclusion: Minimally invasive repair is effective for the treatment of pectus carinatum, even in adult patients.

• Journal of Chest Surgery
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• 제45권6호
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• pp.396-400
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• 2012

Background: Surgery has been the classical treatment of pectus carinatum (PC), though compressive orthotic braces have shown successful results in recent years. We propose a non-operative approach using a lightweight, patient-controlled dynamic chest-bracing device. Materials and Methods: Eighteen patients with PC were treated between July 2008 and June 2009. The treatment involved fitting of the brace, which was worn for at least 20 hours per day for 6 months. Their degree of satisfaction (1, no correction; 4, remarkable correction) was measured at 12 months after the initiation of the treatment. Results: Thirteen (72.2%) patients completed the treatment (mean time, $4.9{\pm}1.4$ months). In patients who completed the treatment, the mean overall satisfaction score was $3.73{\pm}0.39$. The mean satisfaction score was 4, and there was no recurrence of pectus carinatum in patients who underwent the treatment for at least 6 months. Minimal recurrence of pectus carinatum after removal of the compressive brace occurred in 5 (38.5%) patients who stopped wearing the compressive brace at 4 months. Conclusion: Compressive bracing results in a significant improvement in PC appearance in patients with an immature skeleton. However, patient compliance and diligent follow-up appear to be paramount for the success of this method of treatment. We currently offer this approach as a first-line treatment for PC.

• Journal of Chest Surgery
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• 제40권5호
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• pp.369-375
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• 2007

배경: 새가슴 환자들은 돌출된 앞가슴으로 인해 옷을 입어도 표시가 나서 미용적인 불편함을 호소한다. 이의 치료법으로는 돌출된 늑연골을 절제하는 외과적 수술법을 시행하는데 이는 광범위한 수술 상처 및 통증, 수술 후의 합병증 등을 유발할 수가 있다. 이에 비수술적 치료법으로 교정기를 이용한 치료법을 시행하였으며 교정을 통한 치료의 유용성과 효과 등을 평가하고자 본 연구를 시행하였다. 대상 및 방법: 2001년 1월부터 2005년 12월까지 새가슴으로 본원에서 교정기를 이용한 치료를 시행 받은 환자들 중 하루 종일 착용을 한 환자들 109명을 대상으로 진행을 하였다. 교정을 시작 후 $6\sim9$ 개월이 지난 후 환자의 만족도를 조사하였다. 만족도의 평가는 1에서 4까지로 하여 1은 전혀 교정이 안된 경우, 2는 아주 약간 교정이 된 경우, 3은 어느 정도의 교정 효과는 있으나 현저히 좋아졌다고는 생각하지 않는 경우, 4는 아주 현저히 교정이 되었다고 생각하는 경우로 하였다. 어린이의 경우는 보호자의 주관적인 평가를 받았고 중학생 이상의 연령에서는 환자가 직접 만족도를 평가하도록 하였다. 결과: 전체적인 만족도의 평균 점수는 $3.93{\pm}0.33$이었다. 또한 109명 중 6명(5.5%)에서 교정기를 제거 후 재발이 있었으며 6명 중 4명은 본인이 임의로 교정을 중단한 환자였다. 6명 모두가 다시 교정기 착용 후 3개월 이내에 재교정 효과를 보았다. 압박 교정의 합병증으로는 109명의 환자들에게서 모두 나타난 처음 교정기를 착용할 때 느끼는 불편함, 76명(69.7%)에서 나타난 교정기로 인한 피부발진과 16명(5.5%)에서 나타난 교정기의 과도한 압박으로 인한 피부 변색 외에 특별한 부작용은 없었다. 피부발진과 피부 변색은 교정기 제거 후 수개월 내에 정상으로 돌아왔다. 결론: 새가슴 환자들에게 교정기를 이용한 비수술적 치료법은 어린이와 청소년들에서 별다른 부작용 없이 미용적으로 효과가 있음을 알 수 있었다. 교정기를 이용한 비수술적 치료는 마취와 수술에 대한 두려움 등으로 수술을 기피하는 새가슴 환자들에게 수술의 대안치료법으로 도움이 되리라 생각된다. 그러나 정확한 치료효과와 재발에 관하여서는 장기적인 추적 관찰이 필요하다.

• Journal of Chest Surgery
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• 제49권1호
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• pp.29-34
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• 2016

Background: Pectus excavatum (PE) and pectus carinatum (PC) are the most common chest wall deformities. In this study, we aimed to characterize how patients obtained information about these deformities, as well as patients' family history, associated medical problems, and postoperative satisfaction after the Nuss and Abramson procedures. Methods: This cross-sectional retrospective study included patients who were operated by a single surgeon between 2006 and 2013. Follow-up calls were made after approval of our institution's ethics committee. We reached 207 of the 336 PE patients (61.6%) and 73 of the 96 PC patients (76%). Results: The majority of the patients were male (85% of the PE patients and 91.8% of the PC patients). The age of diagnosis of PE was $14.52{\pm}0.51years$ and the age at the time of operation was $17.89{\pm}0.42years$; for PC patients, the corresponding ages were $15.23{\pm}0.55years$ and $16.77{\pm}0.55years$, respectively. A total of 70% of the PE patients and 63.8% of the PC patients obtained information about pectus deformities through the Internet. In 27.1% of the PE patients with an associated anomaly, 57.1% (n=13) had scoliosis, while 41.1% of the PC patients with an associated anomaly had kyphosis (n=5). Postoperative satisfaction, as evaluated on a scale from 0 to 10, was $8.17{\pm}0.15$ for PE patients and $8.37{\pm}0.26$ for PC patients. The postoperative pain duration was $51.93{\pm}5.18days$ for PE patients and $38.5{\pm}6.88days$ for PC patients. Conclusion: In this study, we found that most patients with pectus deformities were male. The Internet was an important resource for patients to learn about their deformities. Family history and associated anomalies were identified as important aspects for consideration in the clinical setting. The patients reported high levels of postoperative satisfaction, and pain management was found to be one of the most important elements of postoperative care.

• Journal of Chest Surgery
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• 제53권5호
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• pp.301-305
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• 2020

Background: Radiographic modalities have been commonly used to evaluate pectus carinatum (PC), and compressive orthotic bracing is the most widely accepted treatment method. The aim of this study was to determine the efficacy of 3-dimensional (3D) body surface scanning as an alternative modality for the evaluation of PC. Methods: The medical records of 63 patients with PC who were treated with compressive orthotic bracing therapy between July 2017 and February 2019 were retrospectively analyzed. Using both 2-view chest radiography (posteroanterior and lateral view) and 3D body scanning, the height of maximal protrusion of the chest wall was measured both before and after 2 weeks of bracing therapy. The difference between the pre- and post-treatment measurements was calculated for both modalities, and these differences were compared and analyzed. Results: Based on the comparison between the pre- and post-treatment radiographs, bracing therapy produced favorable outcomes in all patients (p<0.001). The measurements obtained via 3D scanning were strongly correlated with those obtained via chest radiography (r=0.60). Conclusion: Based on the findings of this study, 3D body surface scanning appears to be an effective, radiation-free, and simple method for the post-treatment follow-up evaluation of PC, and thus can be considered an alternative to radiography.

• Journal of Chest Surgery
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• 제51권6호
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• pp.390-394
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• 2018

Background: The nonsurgical treatment of chest wall deformity by a vacuum bell or external brace is gradual, with correction taking place over months. Monitoring the progress of nonsurgical treatment of chest wall deformity has relied on the ancient methods of measuring the depth of the excavatum and the protrusion of the carinatum. Patients, who are often adolescent, may become discouraged and abandon treatment. Methods: Optical scanning was utilized before and after the intervention to assess the effectiveness of treatment. The device measured the change in chest shape at each visit. In this pilot study, patients were included if they were willing to undergo scanning before and after treatment. Both surgical and nonsurgical treatment results were assessed. Results: Scanning was successful in 7 patients. Optical scanning allowed a visually clear, precise assessment of treatment, whether by operation, vacuum bell (for pectus excavatum), or external compression brace (for pectus carinatum). Millimeter-scale differences were identified and presented graphically to patients and families. Conclusion: Optical scanning with the digital subtraction of images obtained months apart allows a comparison of chest shape before and after treatment. For nonsurgical, gradual methods, this allows the patient to more easily appreciate progress. We speculate that this will increase adherence to these methods in adolescent patients.

• Journal of Chest Surgery
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• 제48권5호
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• pp.375-377
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• 2015

We report a case of an entrapped lung after the pectus bar repair of a pectus deformity. The entrapped lung was found incidentally during video-assisted thoracoscopic surgery (VATS) for pneumothorax. Based on VATS exploration, multiple bullae seemed to be the cause of the pneumothorax, but the entrapped lung was suspected to have been a cause of the air leakage.

• Journal of Chest Surgery
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• 제49권3호
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• pp.214-217
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• 2016

Pectus arcuatum is a rare complex chest wall deformity. A 31-year-old female presented with a severely protruding upper sternum combined with a concave lower sternum. We planned a modified Ravitch-type operation. Through vertical mid-sternal incision, chondrectomies were performed from the second to fifth costal cartilages, saving the perichondrium. Horizontal osteotomy was performed in a wedge shape on the most protruding point, and followed by an additional partial osteotomy at the most concaved point. The harvested wedge-shape bone fragments were minced and re-implanted to the latter osteotomy site. The osteotomized sternum was fixed with multiple wirings. With chondrosternoplasty, a complex chest wall deformity can be corrected successfully.