Scaife Eric R, Johnson Dale G, Meyers Rebecka L, Johnson Sidney M, Matlak Michael E
Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
J Pediatr Surg. 2003 Dec;38(12):1748-51. doi: 10.1016/j.jpedsurg.2003.08.045.
The authors present a technique to repair large diaphragmatic hernias that is simple, can be done primarily, and offers a durable closure with living tissue.
A review of congenital diaphragmatic hernias was performed for the period between January 1991 and August 2000. Repair types included primary repair, synthetic patch, or a split abdominal wall muscle flap. The split abdominal wall muscle flap is performed by downward rotation of the internal oblique and transversalis abdominal wall muscles. This repair requires that the initial subcostal incision be positioned at least 4 to 5 cm below the costal margin, low enough to insure an adequate length of muscle will be available to fill the defect.
Eight of 158 children with congenital diaphragmatic hernia underwent repair by abdominal wall muscle flap. Five of 8 had complete agenesis. Five survived the newborn period. Of the survivors, 4 of 5 required an additional surgical procedure, but none have had a recurrent hernia.
The split abdominal wall muscle flap is an effective technique to close large diaphragmatic hernias. The repair was carried out successfully in 8 patients with massive defects. In the surviving patients, the repair has proven to be a durable restoration of the diaphragm.
作者介绍一种修复大型膈肌疝的技术，该技术简单，可一期完成，且能利用活体组织实现持久闭合。
回顾1991年1月至2000年8月期间的先天性膈肌疝病例。修复类型包括一期修复、使用合成补片或劈开腹壁肌瓣。劈开腹壁肌瓣是通过向下旋转腹内斜肌和腹横肌来完成的。这种修复要求最初的肋下切口位于肋缘下方至少4至5厘米处，位置要足够低，以确保有足够长度的肌肉可用于填充缺损。
158例先天性膈肌疝患儿中有8例接受了腹壁肌瓣修复。8例中有5例存在完全性发育不全。5例在新生儿期存活。在存活者中，5例中有4例需要再次进行手术，但均未出现复发性疝。
劈开腹壁肌瓣是闭合大型膈肌疝的有效技术。8例有巨大缺损的患者成功进行了修复。在存活患者中，该修复已被证明是对膈肌的持久修复。
