Southwest Florida’s white-sand beaches, uninhabited islands, and exotic wildlife make our area a dream destination for many, including for Pediatric SurgeonDr. Andre Hebra。
4月，赫布拉博士从佛罗里达州中部搬迁到加入Lee Healthand佛罗里达州西南部的Golisano儿童医院。But Dr. Hebra has much more in mind than just enjoying our natural wonders.
Hebra博士的愿景是使儿童医院成为先天性胸壁畸形的儿童目的地中心，例如Pectus Excavatum，这是最常见的先天性胸壁畸形。
“先天性胸壁畸形计划使我们能够优化患有胸壁异常的儿童的护理，”在普通手术，小儿手术和重症监护方面经过董事会认证的赫布拉博士说。“这种病可能会给儿童带来功能问题，这可能导致难以锻炼，呼吸，甚至可能导致心脏问题。”
什么是pectus excavatum？
pectus excavatum是“空心胸部”的拉丁语术语，是肋骨笼的异常发育，使胸部的外观脱落或沉没。当骨骼和软骨与胸骨（胸骨）相关的骨骼和软骨的异常生长时，这种情况就会发展。Hebra博士解释说，这会导致胸骨向内生长，甚至旋转 - 替代心脏和肺部。
他补充说：“结果，胸部胸部的中心有一个凹陷，这可能非常深而毁容。”“如果病情严重，心脏和肺部可能会受到影响。同样，胸部的外观可能引起重大的社会心理和情感问题。”
Hebra博士指出，Pectus Excavatum在孩子一生的头几年中可能并不明显。案例通常在十几岁的早期发现。该病的确切原因每年影响约400名儿童，但尚不清楚，但似乎是遗传的。
For more than 25 years, Dr. Hebra has centered his practice around the management and development of innovative treatments for pectus excavatum and other congenital chest malformations. Formerly, Chief Medical Officer of Nemours Children’s Hospital in Orlando, he has pioneered research related to chest abnormality treatments, optimizing care for children in the process, especially those with pectus excavatum.
“通常，建议手术是否存在心肺健康问题，例如劳累呼吸困难，”赫布拉说。“还可以进行手术以改善胸部的外观。”
Dr. Hebra says the technical complexity of surgical intervention is quite significant, which demands that patients receive leading-edge, safe, surgical intervention to ensure the best possible outcome.
“这里的团队拥有丰富的经验和知识，了解如何治疗胸壁畸形。结果，我们的专业知识可以最大程度地降低并发症的风险，这有时可能是威胁生命的。”
果皮的症状包括：
- 容忍运动的问题
- Limitations with certain physical activities
- 疲倦
- Chest pain
- 快速心跳或心pal
- 频繁的呼吸道感染
- Coughing or wheezing
How is pectus excavatum diagnosed?
Dr. Hebra and his team diagnose pectus excavatum based on a physical exam and a child's medical history. If needed, other tests might be ordered, such as:
- Computed tomography (CT) scan and/or a chest MRI to see the severity and degree of compression on the heart and lungs
- Echocardiogram to test heart function
- Pulmonary function tests to check lung volume
- 运动压力测试以测量运动耐受性
果皮如何处理？
根据Hebra博士的说法，儿童可能会从各种类型的治疗中受益，例如物理疗法和支撑。选择性患者将受益于微创手术，这被认为是一种选修手术。他说，如果不影响呼吸或外表不会打扰他们，通常不需要治疗的儿童通常不需要治疗。
Hebra博士说：“但是，如果这种病影响孩子的自我形象，使运动或锻炼困难，手术治疗可以改善他们的身体和情感幸福感。”
一个新的非手术方法温和漏斗胸excavatum is an at-home treatment that involves a custom-made vacuum bell device that is applied to the child’s chest. Dr. Hebra has made this available at Golisano now. The bell device, connected to a pump that sucks the air out of it, creates a vacuum that pulls the chest and breastbone forward. Eventually, the chest wall will reshape and remain forward without the use of the bell device.
努斯程序：革命性选择
For children who require surgical intervention to correct pectus excavatum, Dr. Hebra’s program offers the innovative minimally invasive procedure called the Nuss procedure.
“The Nuss procedure has revolutionized the way we manage the condition,” Dr. Hebra says. “Before it became the gold standard, 20 years ago, chest wall repair in children was a highly invasive procedure in which the chest was opened through the front and rib and cartilage had to be resected. The open surgery was often a long and complex operation that left the patient with a noticeable, unappealing scar across the chest.”
The minimally invasive Nuss procedure has changed all that, Dr. Hebra says. Using video-assisted, camera-aided thoracoscopic surgery, the surgeon makes small incisions and places an internal curved metal strut that is specially shaped to fit and correct the patient’s specific type of chest caved-in deformity. The bar pushes out the sternum and ribs, allowing for natural reshaping without cutting or breaking any bone and cartilage structures. A stabilizer bar is added to keep it in place. In 2-3 years, the chest is permanently reshaped, and the bars are removed.
建议对12岁及以上的儿童进行NUSS程序。对于严重的情况，即使在年轻人中也可能有必要运作。
赫布拉博士说：“大多数接受手术的孩子和青少年都做得非常好，对结果和对生活质量的积极影响感到满意。”
减轻疼痛
为了与先天性胸壁畸形计划的领先技术保持一致，赫布拉博士说，他引入了冷冻疗法用于胸壁维修手术。该技术有助于减轻患者的疼痛，加速术后康复，并最大程度地减少与麻醉品相关的风险，以管理术后疼痛。
“Although the Nuss procedure is minimally invasive, the technique involves the bending of ribs and the sternum, which typically causes the patient significant pain.”
赫布拉博士说，在使用冷冻治疗之前，通常会通过大量使用麻醉和受控物质来管理术后疼痛。
“The challenges with narcotic management are its possible side effects and the risk of the patient developing narcotic dependency,” Dr. Hebra notes. “Cryoablation therapy helps minimizes those risks.”
在冷冻化中，Hebra博士使用液氮在手术过程中冻结胸壁的神经，麻木，并大大降低了手术后患者的疼痛水平。
“Post-operative management becomes safer and much better,” Dr. Hebra says. “Recoveries are much faster with less pain. The use of narcotics is lessened, and most importantly, five-to-seven-day hospital stays often become half that. Kids can go home sooner and resume normal activities more quickly because they have less pain.”
Golisano Children’s Hospital由Hebra博士等小儿专家组成的多学科团队，他们可以对您的孩子进行全面评估，以治疗和管理先天性胸壁畸形。
Call 239-343-7474 for a consultation or to make an appointment with the pediatric experts at Golisano Children’s Hospital of Southwest Florida.