Kako izvršiti procenu deformiteta grudnog koša kod dece sa pectus-оm excavatum-om – procena podudarnosti metoda
Sažetak
Uvod/Cilj. Pectus excavatum (PE) je najčešći deformitet frontalnog aspekta zida grudnog koša kod dece. Posebnu dilemu predstavlja stepen deformiteta koji treba da bude podvrgnut hirurškom lečenju. Cilj rada bio je da se uporedi više morfoloških metoda procene stepena deformiteta i utvrdi podudarnost između njih, kao i povezanost između funkcionalnih i morfoloških abnormalnosti na ehokardiografiji. Metode. Ispitivanjem je obuhvaćeno 35 bolesnika sa PE, uzrasta od 7 do 15 godina. Kod svih bolesnika je sprovedena neinvazivna procena deformiteta grudnog koša fotografskom metodom (surogat kliničkog pregleda), nativnom radiografijom (RTG) i kompjuterizovanom tomografijom (CT), kao i ehokardiografskim pregledom. Rezultati. U ispitanom uzorku češće je bio zastupljen muški pol (67,5%), kao i deca sa Halerovim indeksom (HI) > 3,5 (86,7% dece). U cilju procene podudarnosti metoda, utvrđena je značajna korelacija indeksa aficiranog segmenta sternuma (ASt) i ukupne dužine sternum LSt (ASt/LSt) određivanog na fotografiji sa onim koji je određivan na CT snimku grudnog koša (p = 0.001). Pored toga, pokazana je i korelacija između HI određenog putem RTG i CT snimka (p = 0.012). Suprotno navedenom, uprkos visokoj učestalosti ehokardiografskih abnormalnosti (69%) one nisu bile u korelaciji sa stepenom izraženosti morfoloških deformiteta zida grudnog koša. Zaključak. Detaljnim kliničkim pregledom i fotografskom metodom procene, zajedno sa RTG metodom, može se utvrditi težina deformiteta sa visokom podudarnošću u odnosu na CT grudnog koša. Na ovaj način, moguće je decu sa PE koja nisu kandidati za hirurško lečenje poštedeti od ponavljanja CT pregleda grudnog koša koji se sprovode u cilju praćenja razvoja deformiteta tokom rasta deteta. Ehokardiografska procena ostaje neophodni i sastavni deo procene stanja dece sa PE.
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