Forget A P, Fleyfel M, Vallet B, Richart P, Arbon G, Saudemont A, Wurtz A
Département d'Anesthésie-Réanimation Chirurgicale II, CHRU de Lille, Hôpital Claude-Huriez.
Ann Fr Anesth Reanim. 1992;11(1):111-4. doi: 10.1016/s0750-7658(05)80329-6.
Two cases are reported of cardiac herniation complicating intrapericardial pneumonectomy in the early postoperative period. Both patients had a radical pneumonectomy for right-sided bronchial carcinoma invading, in one patient, the carina and the superior vena cava. The pericardial defect, made necessary by the surgical procedure, had not been closed in either patient. About two hours after the end of surgery, both patients, lying supine, developed a state of shock, with tachycardia and arterial hypotension. The diagnosis of cardiac herniation was made in both cases on the chest film. Placing the patient on his left side was only partly efficient in one patient, slowing the heart rate from 160 b.min-1 to 120 b.min-1 and increasing the systolic blood pressure (from 60 mmHg to 80 mmHg). Both patients therefore required to be operated on again. In one patient, the heart had completely herniated through the pericardial defect, and had turned to the right side about the vena caval axis; in the other patient, partly improved by being turned to his left, the heart had returned to its normal position. The pericardial defects were closed in both cases with a strip of dura mater previously treated with 2 (ethyl-mercurithiol-5-benzoxazol) carboxylic acid. The immediate postoperative course was uneventful. Unexpected symptoms and sign occurring in the early postoperative period after intrapericardial pneumonectomy must imperatively lead to carrying out a chest X-ray.
报道了两例心包内肺切除术后早期并发心脏疝的病例。两名患者均因右侧支气管癌行根治性肺切除术，其中一名患者的癌肿侵犯了隆突和上腔静脉。由于手术操作的需要，两名患者的心包缺损均未闭合。术后约两小时，两名仰卧位患者均出现休克状态，伴有心动过速和动脉低血压。两例均通过胸部X线片确诊为心脏疝。将一名患者置于左侧卧位仅部分有效，心率从160次/分钟降至120次/分钟，收缩压从60 mmHg升至80 mmHg。因此，两名患者均需要再次手术。一名患者的心脏已完全通过心包缺损疝出，并围绕腔静脉轴转向右侧；另一名患者通过转向左侧部分好转，心脏已恢复至正常位置。两例均用心包缺损均用一条预先用2-（乙基汞硫醇-5-苯并恶唑）羧酸处理过的硬脑膜条带封闭。术后即刻病程平稳。心包内肺切除术后早期出现的意外症状和体征必须立即进行胸部X线检查。
