Nuss手術の患者満足度調査  [in Japanese] Patients' Satisfaction With the Nuss Procedure  [in Japanese]

【目的】胸腔鏡補助下Nuss手術(本術式)の術後経過と患者満足度を調査することを目的とした.【方法】埼玉県立小児医療センター外科では2000年7月から2007年12月までの間に54例に対して本術式を行い,41例がバー抜去術を終了している.今回,バー抜去後症例を対象として,診療録の後方視的検討と電話によるアンケート調査を行った.アンケートの質問は現在の胸郭形態を5点満点で自己採点,手術を受けてよかったか,他人にも勧めるかの3つとした.【結果】回答が得られた39例の初回手術時年齢の中央値は6歳11か月(5歳3か月〜15歳9か月),CT indexの中央値は5.6(3.1〜15.3)であった.感染により術後21日目にバーを抜去した1例を除くと,バー挿入期間の平均は2年で,術後経過期間の中央値は29か月(2〜65か月)であった.胸郭形態に対する自己採点の平均は4.2点(5点:20例,4点:11例,3点:5例,2点:3例),38例がやってよかったと答え,34例が他人にも勧めると回答した.バー抜去後に再陥凹が認められるようになったと回答した症例が8例(21%)あった.そのうちの7例は,外来主治医および筆者が評価するとほぼ正常から軽度と言える程度であり,6例は経過観察中である.残る1例は患者本人の希望が強く他院で再手術を受けている.著しく再陥凹した症例も1例認められた.【結語】本術式は多くの症例で良好な胸郭形成が行われ,患者満足度は良好である.しかし,術後胸郭形態の認識において医療者側と患者側に若干の差があることと,バー抜去後に再陥凹する危険性があることも明らかとなった.

Purpose: The purpose of this study is to investigate the satisfaction of patients who have already finished bar removal. Methods: Fifty-four patients with pectus excavatum underwent the Nuss procedure between July 2000 and December 2007 and the bar was removed in 41 of them at our hospital. A telephone questionnaire was administered to their parents or the patients (12 years old or older). The questions were as follows: 1) self-assessment of the present thoracic form on a 5-point scale, 2) whether it was good to have undergone the Nuss procedure (Y/N), 3) whether the patient will recommend this procedure to another patient (Y/N). Results: Thirty-nine patients responded to the questionnaire. Median age at the bar insertion was 83 months (range: 63-189 months). The bar was removed about 2 years after the initial operation. The median period after removal was 29 months (range: 2-65 months). The mean point for the thoracic form was 4.2 (5 points: 20, 4 points: 11, 3 points: 5, 2 points: 3). Thirty-eight patients answered that they were satisfied with this procedure. Thirty-four patients answered that they would recommend this procedure to another patient. Eight patients reported that redepression occurred after bar removal. Six of them are under observation because their thoracic deformity is mild. Conclusions: Patients' satisfaction with the Nuss procedure was high. However, our study shows the possibility of post-removal recurrence. There seems to be a tendency for patients to assess their thoracic form more strictly than the doctors.