Nuss法の術後に疼痛が遷延した2例

Persistent Pain After Surgery with the Nuss Procedure for Pectus Excavatum: Two Cases

はじめに

　漏斗胸は，肋骨および肋軟骨の変形により前胸部が陥凹する先天性疾患である。現在のところ漏斗胸に対してはNuss法が標準的な術式となっている。Nuss法の本質は，チタン製矯正バー（通称ペクタスバー；以下，バー）を装着して胸郭の形態を修正する矯正治療である。したがって同法は，胸郭が柔軟な小児の患者には適している。しかし，成人の患者では肋軟骨の効果により胸郭の弾性が損なわれているため，Nuss法を原法どおりに施行すると強い疼痛が遷延し，患者のQOLを著しく低下させる場合がある。

　本稿では，他院においてNuss法による胸郭形成が施行された後，疼痛が遷延したために，当院においてリカバリー手術を行った2例を紹介する。この経験に基づき，術後疼痛が遷延した原因ならびにその予防策につき考察する。

　Although the Nuss procedure is frequently used in the treatment of both child and adult patients, its use can result in unsatisfactory outcomes for patients unless it is applied with thorough planning. We describe two cases in which the patients had persistent pain after undergoing surgery with the Nuss procedure for pectus excavatum at other hospitals. For the first case (a 32-year-old female), inappropriate curvature of a correction bar had been causing the patientʼs pain. Removal of the inappropriately formed bar eliminated the pain. For the second case (a 53-year-old female), the previous surgeon had placed two bars on the patientʼs thorax and connected the two bars with a special stabilizer. The two bars had been connected so firmly that they had restricted the respiratory movement of the patientʼs thorax, causing pain and discomfort. We removed the bars and connector to increase the ribsʼ mobility. The patientʼs pain and discomfort then disappeared. In the Nuss procedure, the patientʼs thorax is forcibly elevated by correction bars (and sometimes stabilizers). Surgeons must take the greatest care so that the apparatus does not produce excessive stress on the ribs and does not restrict the patientʼs respiratory movement.