Massard G, Wilk A, Dumond P, Rodier-Bruant C, Wihlm J M, Morand G
Service de Chirurgie Thoracique, CHRU, Strasbourg.
Ann Chir Plast Esthet. 1992 Jun;37(3):329-32.
The authors relate two case-reports of diaphragmatic hernia occurring after antero-lateral chest-wall resection and repair with an omental flap. Both patients had undergone a prior lung resection for bronchogenic cancer, and the indication for chest-wall resection was parietal neoplastic recurrence. In both patients, the omental flap was brought up to the chest wall defect by a direct transdiaphragmatic route; prosthetic material was note used. The hernia presented once as early post-operative evisceration, and once as proximal obstruction due to gastric herniation. The causes of these two complications are analysed. Omentoplasty was justified twice, since the latissimus dorsi had been severed during the prior thoracotomy. Prosthetic material might have been useful to one of the patients, but not to the second who had undergone pneumonectomy. The transdiaphragmatic passage of the omentoplasty was certainly responsible for the herniae and should be avoided.
作者讲述了两例在胸壁前外侧切除并用网膜瓣修复后发生膈疝的病例报告。两名患者均曾因支气管源性癌接受过肺切除术，胸壁切除的指征是胸壁肿瘤复发。在两名患者中，网膜瓣均通过直接经膈途径上提到胸壁缺损处；未使用假体材料。疝一次表现为术后早期脏器脱出，另一次表现为胃疝导致的近端梗阻。分析了这两种并发症的原因。由于在先前的开胸手术中背阔肌已被切断，两次进行网膜成形术都是合理的。假体材料可能对其中一名患者有用，但对另一名接受了肺切除术的患者则无用。网膜成形术经膈通道肯定是导致疝的原因，应避免。
