Objective To compare the safety and feasibility of two-incision modified and traditional Nuss procedures for children with pectus excavatum.Methods From October 2005 to October 2007,totally 208 cases of pectus excavatum received Nuss surgeries,including three-incision traditional Nuss in 103 cases and two-incision modified Nuss in 105 cases,in our hospital. The perioperative records,complications and the surgical outcomes of the two groups were compared.Results The procedures were completed in all of the 208 patients.The rate of good outcomes in the two groups were similar (94.3% vs.88.3%,x~2=2.318,P= 0.128).Whereas,the operation time and hospital stay of the modified group was significantly shorter than those in the traditional group [(39.2?7.4) min and (6.3?0.7) d vs (45.4?9.2) min and (7.2?0.9) d;t=5.361,P=0.000 and t=8.059,P=0.000]. Furthermore,the modified group had significantly less intraoperative blood loss (median,2.8 ml) than the other group (x~2=5.158, P=0.000).No significant difference was found in the rage of postoperative complications between the two groups (Traditional group: pneumothorax in 1,haemothorax in 1,pericardial perforation in 1,and injuries to the diaphragm or liver in 2;Modified group: pneumothorax in 4,and pericardial perforation in 1;x~2=0.001,P=0.975).The patients were followed up for 3 to 30 months, during which none of them had recurrence or long-term complications.Conclusions Two-incision modified Nuss procedure is not only less traumatic,but also results in shorter operation time and hospital stay,and less blood loss,than the traditional procedure.In addition,as the contralatcral structures are visible during the operation,the modified method is more simple and safer.

Objective To verify the safety of non-thoracoscopic Nuss procedure,and review our experience in correction of pectus excavatum by Nuss procedure with post-implantation thoracoscopic assistance.Methods 191 patients with pectus excavatum were surgically corrected by Nuss procedure with post-implantation thoracoscopic assistance.There were 146 boys and 45 girls,The age ranged from 2.8 to 20 years with mean age was ( 6.46 ± 3.36) years.Hailer' s index was 4.68 ± 1.84.The operation was performed under Non-thoracoscopic assistance first and then with thoracoscopic observation.Results The operation in all patients had been performed successfully.The time of the operation ranged from 27 to 50 minutes with mean time was ( 32.49 ± 2.79) minutes.The average bleeding volume during procedure was ( 2.19 ± 0.87 ) ml.The durstion of follow-up was 10 to 23 months.All patients have been satisfied with their surgical correction.The postoperative complication was 13 cases( 6.81％ ).The bar outsides the pleura in both sides was 18 cases( 9.42％ ).The bar outsides the right pleura was 23cases( 12.0％ ).The bar outsides the left pleura was 17 cases( 8.90％ ).Conclusion Nuss procedure with non-thoracoscopic assistance for correction of poctus excavatum is safety if the surgeon experienced and have certain methods.Post-implantation thoracoscopic Nuss procedure is safer,and can deal with the damage caused by non-thoracoscopic assistance.

Objective To summarize the experience of diagnosis and treatment of pectus excavatum associated with congenital pulmonary disease in children.Methods The data of 91 patients with pectus excavatum associated with congenital pulmonary disease was collected from July 2002 to August 2010 in Beijing Children's Hospital.There were 64 males and 27 females.30 patients with pectus excavatum associated with congenital pulmonary cyst,congenital cystic adenomatoid malformation,pulmonary sequestration,and some severe cases of congenital lobar emphysema received the Nuss surgery and lobectomy simultaneously.Results 30 cases with pectus excavatum asseeiated with congenital pulmonary disease received simultaneous Nuss procedure and lobectomy.All cases were confirmed by pathology and recovered uneventfully.Conclusion Chest CT scan is an effective way to evaluate pectus excavatum associated with pulmonary diseases.Whether surgery is needed for the pulmonary disease depend on the specific types of disease,age and other various factors.Simultaneous surgery for pectus excavatum and pulmonary disease can lower the risk of the multiple operations,and reduce the financial burden of famihes.

Objective To compare the safety and feasibility of thoracoscopic extrapleural Nuss procedure with traditional intrapleural Nuss procedure. Methods Total 252 patients with pectus excavatum received Nuss surgery from July 2008 to June 2009 in Beijing children' s hospital. Patients had following condition were excluded; (1) recurrent pectus excavatum; (2) complicated with other diseases, and need simultaneous surgery; (3) older than 13-year-old; (4) extensive depression, and need two Nuss bar; or (5) extreme severe or severe unsymmetric. 131 cases were selected in our study and they were randomly divided into two groups, thoracoscopic extrapleural Nuss procedure ( n = 62 ) and traditional intrapleural Nuss procedure ( n =69). Perioperative information, postoperative complications, effectiveness and the location of the Nuss bar were compared between two groups. Results All the 131 patients had completed the procedure successfully. There were no significant differences in age, Haller index; surgical effects, operation time, blood loss, and hospital stay, between two groups. Postoperative complications between the two groups are not significant. 131 patients were followed up from 14 to 26 months, and no recurrence and long-term complications occurred. About more than half cases of extrapleural Nuss procedure group were break the pleural into thoracic cavity. Conclusion Both extrapleural and intrapleural Nuss procedure are safe and effective for pectus excavatum, but extrapleural Nuss procedure have no advantage to the intrapleural Nuss procedure, also it' s hard to observe the other side of thoracic cavity during the surgery, and not easy to grasp and to promote.

Objective Minimally invasive technique was used in the treatment of pectus carinatum. Indication, techni-cal details and perioperative complication are discussed in this paper. Methods From March 2008 to January 2009, 6 patients with pectus carinatum underwent minimal invasive operation by using the principle of Nuss procedure in which pressure applied through a curved steel bar that was placed subcutaneously anterior to the sternum, via lateral thoracic incisions. Preoperative CT scan were performed and Hailer index was used as operative indication. Results The average age of patients was (13.6 ± 1.94) years (range, 10 - 16 years). They were all males. The mean operation time was (104.17 ± 15.63) minutes. The av-erage blood loss was (5.17±2.56) ml. The mean hospital stay was (5.67±0.82) days. Postoperative follow-up was 1 -11 months. Displacement of the stablizer was the only complication that was corrected by further fixation procedure. COnClusion The minimally invasive technique for the treatment of peetus earinatum is safe and effective with minimal complications. It can be selected as an alternative techniques and the appropriate age for this procedure is 10-16 years.

Objective To study the application CT scans in Nuss procedure for pectus excavatum. Metlhods 648 children with pectus excavatum underwent Nuss procedure from July 2002 to September 2008 The preoperative CT scan was carried out for evaluation of the deformity degree and morphology classification of chest wall malformation, the deformity in relation with adjacent tissue and associated different disorder. Results Nuss procedure was successfully performed in all 648 patients. The preoperative CT scan showed medium deformity of the pectus excavatum in 73 cases ( 11.27% ) and severe deformity in 575 cases (88.73%). Morphologic classification of the pectus excavatum were symmetric type in 407cases (62.81% ) , eccentric type in 83( 12.81% ) ,and unbalanced type in 158( 24.38% ). 116 cases with pectus excavatum were associated with other different disorders, among them 55 cases ( 17.9% )were diagnosed by CT scan. 28 cases received stimultanously operation for their abnormalities. Conclusion CT scan is a useful tool for evaluation the deformity degree and morphology classification, direct the operation, reduce the complications and find other different disorders. It should be a routine examination before Nuss procedure.

Objective To access the development of thoracic volume of pectus excavatum use of Nuss operation used CT-basedpulmonary volumetric evaluation.Methods 98 patients with pectus excavatum in Beijing Children's Hospital under Nuss operation were documented.All patients had CT scan pre-and postopration.The CT-scan's data were calculated as lung's volume by handdraw-layers summation method.The lung's volume result was compared,and enquiry the position in CT lung volume developmental scale.Results The lung's volume was elevated 28.3％ after operation.The development of thoracic volume was keep with age,70％ was maintained and 15％ was elevated.Conclusion Nuss operation can prevent the decrease of thoracic volume in pectus excavatum.

Objective The purpose of the study is introducing the concept and classification of congenital pulmonary airway malformation(CPAM),and summarizing the clinical features,imaging,pathological features and treatment methods of congenital pulmonary airway malformation.Methods 283 cases were retrospectively analyzed from April 2012 to November 2017,which were treated by thoracic surgery,pathological diagnosis were isolated congenital pulmonary airway abnormalities except combination of other deformity surgery at the same time.we analyze the clinical data,surgical methods,operation and postoperative pathology classification.Results All the 283 cases were successfully performed without severe surgical complications and secondary thoracotomy.There were 167 males and 116 females,male∶ female =1.44∶1;Age:0.77-166 months,median age 20.67 months;The operation time was 25-220 min,median time was 75min,and the bleeding volume was 1-250 ml,and the median blood volume was 5 ml.Among them,80 patients underwent thoracotomy,203 cases of thoracoscopic surgery,19 cases were transferred.Postoperative pathology 57 cases of type 1,194 cases of type 2,5 cases of type 3,9 cases of type 4.Conclusion CCAM has been renamed as congenital pulmonary airway malformation (CPAM) and has been reclassified.CPAM can be detected by imaging examination,and the diagnosis is based on histopathological examination,and the prognosis is better after the complete surgical resection of lung lesions.Thoracoscopic minimally invasive surgery could make less surgical trauma,small and beautiful wound,which is suggested to be promoted widely.

Objective:To determine the safety and efficacy of sandwich surgery in minimally invasive orthopedic surgery.Methods:A retrospective analysis was performed on 79 pectus carinatum patients undergoing minimally invasive orthopedic surgery admitted to the Department of Thoracic Surgery, Beijing Children's Hospital from July 2016 to July 2018, including 53 cases in the Abramson surgery group and 26 cases in the sandwich surgery group.Results:79 cases successfully completed the operation, the difference in complication rate between the two groups was not statistically significant. All cases were followed up to two years after bar removal, and no recurrence during the follow-up period. The excellent rate of orthopedic effect in sandwich surgery group was higher than that in Abramson surgery group.Conclusion:Sandwich surgery is safe, feasible and can achieve satisfactory postoperative results. It can be used as a surgical option for the treatment of pectus carinatum with depression or depression after orthosis.

Pectus carinatum (PC) is one of the most common chest wall anomalies, which is characterized by the protrusion of the anterior chest wall including the sternum and adjacent costal cartilages. Mildly patients suffer from mental problems such as self-abasement, while severely suffering patients are disturbed by significant cardiopulmonary symptoms. The traditional Haller index, which is widely used clinically to evaluate the severity of PC, is deficient in diagnosis efficiency and classification. This paper presents an improved Haller index algorithm for PC: first, the contour of the patient chest in the axial computed tomography (CT) slice where the most convex thorax presents is extracted; and then a cubic B-spline curve is employed to fit the extracted contour followed by an eclipse fitting procedure; finally, the improved Haller index and the classification index are automatically calculated based on the analytic curves. The results of CT data analysis using 22 preoperative and postoperative patient CT datasets show that the proposed diagnostic index for PC can diagnose and classify PC patients correctly, which confirms the feasibility of the evaluation index. Furthermore, digital measurement techniques can be employed to improve the diagnostic efficiency of PC, achieving one small step towards the computer-aided intelligent diagnosis and treatment for pediatric chest wall malformations.