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The Nuss procedure is a minimally-invasive procedure, invented in 1987 by Dr. Donald Nuss for treating pectus excavatum.〔(Dr. Donald Nuss, Pioneer of the Nuss Procedure )〕 He developed it at Children's Hospital of The King's Daughters, in Norfolk, Virginia. The operation typically takes approximately two hours. Through two small incisions in the side of the chest, an introducer is pushed along posterior to the sternum and ribs, and anterior to the heart and lungs. Then a concave stainless steel bar is slipped under the sternum, through the incisions in the side of the chest. A third, smaller incision is made to insert a thoracoscope (small camera) used to help guide the bar. Taller patients, older patients, or patients requiring extensive correction may receive two or more bars. All bars may be placed through two incisions or additional incisions may be made. The bar is then flipped, and the sternum pops out. To support the bar and keep it in place, a metal plate called a stabilizer may be inserted with the bar on one side of the torso. PDS sutures may also be used in addition to the stabilizer. The stabilizer fits around the bar and into the ribcage. The bar and stabilizer are secured with sutures that dissolve in about six months. Some surgeons have achieved excellent results using only pericostal sutures, without the use of stabilizers. For older children who have more ossified bones, an additional option the surgeon has is to make an incision across the sternum so the bar is attached with a wire to the sternum to avoid bar displacement. Older children's bones do not conform as easily to the bar, thus increasing the risk of bar displacement, so the wire attaching the bar directly to the sternum may help avoid a second surgery to correct bar displacement. Eventually, the bar is secured with muscle tissue that regrows during the recovery time. Although initially recommended only for younger patients, the Nuss procedure is now commonly used on patients in their thirties and forties with excellent results.〔 Postoperative evaluation indicates a significant improvement in pulmonary function studies and a high proportion of patients report improvements in well being and an increase in exercise tolerance.〔 Although this procedure is categorized as "minimally invasive", one must not infer that recovery from this procedure is minimal. Post-operative pain control can be quite challenging, thus requiring multi-modal pain management such as epidural. Nurses who attend these patients post operation generally concur that this operation is one of the more difficult recoveries of any operations for children. ==Recovery== Recovery time is generally four to five days as an in-patient, depending on the patient age, activity level, co-morbidities and post-operative complications (if any), followed by time at home to overcome the pain and to let the bar settle into place. Sleep will be hampered because of the pain, discomfort and inability to sleep on either side of the body. Breathing can be difficult because of the stiffness of the bar and post-operative pain, but this generally improves within a few weeks to a month. Patients younger than fifteen often require only two to four weeks at home after being discharged from the hospital for recovery. However, older children and adults typically require a greater recovery time due to the increased ossification (and thus decreased flexibility) of their bones. In this case, the difficulty and length of recovery should be carefully considered prior to making the decision to undergo the operation, as the limitations to lifestyle, functionality and comfort can be dramatic for many months. This cannot be understated for older children, which is why many doctors do not recommend this procedure unless medically necessary (i.e. not for cosmetic reasons). Fully grown adults may require from four weeks to many months before they can resume normal activities, including work. For six to twenty-four hours after the operation, the patient generally will have a Foley catheter to minimize risk of movement that could displace bar, and because the epidural can interfere with normal urination. The patient may also receive thoracic epidural analgesia in the back for two to five days depending on patient recovery. For six weeks, physical activity should be limited (i.e. no running or strenuous physical activity, and lifting is limited to ten pounds or less). Walking for exercise and breathing exercises aid in recovery. It is sometimes suggested that weight-training should be limited or eliminated for up to three months. It is also recommended that any sports where contact may occur should be avoided. However, aerobic sports are, in fact, encouraged, as results after bar removal are best maintained in patients who have stimulated their cardiopulmonary systems whilst the bar was in place The restoration of the patients physical abilities can take up to ten months. However, in the majority of cases, patients report a return to their preoperative physical state after roughly six months. Many patients choose to return to work at this point. Despite this physical recovery, patients are recommended to avoid more physical situations such as contact sports until after the bar has been removed. Many Pectus Excavatum patients exhibit psychological symptoms associated with the cosmetic appearance of their disorder . For many, it is the driving force behind undergoing the Nuss procedure. The recovery from these psychological symptoms can also take some time, though many patients report improvements in confidence and self-esteem after only a few weeks, once the effects of the surgery can be noticed. Ultimately, almost all patients report a noticeable improvement in their confidence and body image after they have completely recovered from the operation. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Nuss procedure」の詳細全文を読む スポンサード リンク
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