Skurðaðgerðir við trektarbringu

Deformity of the thorax is considered a relatively common deformity of wich funnel chest is the most common. The incidence in the general population has been reported 7.9/1000 based on examinations of 15000 individuals in London. During the period from March 1963 to January 1991, there were 61 procedures performed for correction of funnel chest at the Department of Thoracic Surgery, University Hospital, Landspitalinn, Reykjavik, Iceland. The patients ranged from 4 to 36 years of age, 45 males and 16 females . Fifty three were considered to have severe deformity and 8 less severe. All the procedures for funnel chest were performed in the same way after 1970. Transverse or longitudinal skin incisions were made over the sternum, the depressed costal cartilages on both sides were resected subperichondrially, transverse sternal osteotomi was done above the depressed part and the sternum lifted anteriorly and fixed with an iron rod driven through the sternum. The ends of the rod were sitting on the ribs on both sides and fixed with a wire to a rib at one end but no fixation was at the other end, thus giving the rod opportunity to move with breathing and exertion. The rod was usually removed after approximately 12 months when the thorax was stable. The cosmetic results were considered good or fair in 54 cases but unsatisfactory in six and in one case informations were missing from the medical record. Spirometry was performed in 29 cases and showed minor deviation in pulmonary function in 13 but was grossly abnormal in one. E.C.G. was performed in 53 cases with minor abnormality in 14 but markedly abnormal in one. Heart catheterizations were done in 2 cases one was normal and the other abnormal. It was the same patient who had severe symtoms of pulmomary and cardiac dysfunction before operation, but he became completely asymtomatic postoperatively. There was no mortality or severe complications. There were six infections but those and other minor complications could be treated easily. In conclusion, we consider that the main indication for surgery because of funnel chest is cosmetic and our view is to be conservative in our recommendations for repair.
Aflögun á bringu er talin nokkuð algeng og oftast meðfædd, en algengi hefur ekki verið kannað á Íslandi. Langalgengasta aflögunin er trektarbrínga og samkvæmt könnun í London 1962 reyndist hún 7,9 %0. Tilgangur þessarar rannsóknar var að athuga þá sjúklinga, sem farið hafa í aðgerð á Landspítalanum vegna trektarbringu. Efniviður er fenginn úr sjúkraskrám handlækningadeildar og göngudeildar. Frá mars 1963 til ársloka 1990 voru gerðar 89 aðgerðir vegna aflögunar á bringu og af þeim var 61 við trektarbringu. Samkvæmt áliti skurðlækna voru 53 taldir hafa mikla trektarbringu en átta töluverða. Tuttugu og tveir sjúklinganna höfðu engin líkamleg einkenni fyrir aðgerð en 39 höfðu huglæg einkenni þar sem verkir og þreyta voru algengust. Hlutlæg einkenni voru fátíð og rannsóknir fyrir. aðgerð sýndu að einungis 14 höfðu minniháttar öndunarskerðingu og 12 minniháttar frávik frá eðlilegu hjartalínuriti. Aðeins í einu tifelli var hægt að sýna fram á öndunarbilun og alvarlega hjartabilun fyrir aðgerð. Aðgerðardauði var enginn. Aukakvillar voru nokkrir, sá helsti sýking í skurðsári hjá sex sjúklingum. Sjúkrahúslega var löng, eða yfir 14 dagar hjá 22 sjúklingum og frá sjö til fjórtán dagar hjá 39. Arangur aðgerða var góður að mati skurðlækna hjá 45, viðunandi hjá níu, lélegur hjá sex en í einu tilviki vantar upplýsingar í sjúkraskrá. Niðurstaða okkar er sú að hér sé fyrst og fremst um fegrunaraðgerð að ræða og því beri að sýna fyllstu íhaldssemi varðandi þær, enda eru þetta stórar aðgerðir, sem hafa í för með sér langa sjúkrahúslegu og hægfara bata.