Nuss procedure for Pectus excavatum repair: critical appraisal of the evidence

Objective: To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence.Methods: We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results: The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications, blood transfusion, hospital stay and time to ambulation. The Nuss operation was faster than the Ravitch (mean difference [MD] = -69.94 minutes, 95% CI: -139.04, -0.83).Conclusion: In the absence of well-designed prospective studies to clarify the evidence, especially in terms of aesthetics and quality of life, surgical indication should be individualized and the choice of the technique based on patient preference and experience of the team.

研究目的：基于现有科学证据，评估Nuss技术（Nuss technique）矫正漏斗胸（pectus excavatum）的有效性与安全性。研究方法：本研究遵循系统检索、文献筛选、数据提取与严格评价的流程开展证据综合。结局指标按重要性分级，并采用推荐意见分级、评估、制定与评价（Grading of Recommendations Assessment, Development and Evaluation, GRADE）方法进行质量评价。研究结果：文献筛选流程最终仅纳入1篇系统评价，该评价综合了9项比较Nuss术与Ravitch术的观察性研究结果。所得证据质量被评为低与极低等级。相较于Ravitch术，Nuss术会增加血胸（相对风险RR=5.15；95%置信区间CI：1.07~24.89）、气胸（RR=5.26；95%CI：1.55~17.92）的发生率，以及再次干预的需求（RR=4.88；95%CI：2.41~9.88）。两种术式在总体并发症、输血需求、住院时长与下床活动时间方面无统计学差异。Nuss术的手术时长较Ravitch术更短（均数差MD=-69.94分钟，95%CI：-139.04~-0.83）。研究结论：在缺乏设计良好的前瞻性研究以明确相关证据（尤其是美学效果与生活质量相关证据）的情况下，手术适应证应实现个体化，术式选择需基于患者偏好与手术团队的操作经验。