Baldassarre Emanuele, Valenti Gabriele, Gambino Marco, Arturi Alessandro, Torino Giovanni, Porta Ilaria Prosperi, Barone Marco
Department of General Surgery, San Pietro Hospital--Fatebenefratelli, Rome, Italy.
J Laparoendosc Adv Surg Tech A. 2007 Jun;17(3):302-6. doi: 10.1089/lap.2005.0046.
The traumatic diaphragmatic hernia (TDH) may appear acutely after a blunt or penetrating trauma, or it can remain missed also for many years. The discussion about the utility of a laparoscopic repair in acute and chronic TDH is controversial.
In this paper, we present two cases of chronic TDH that were successfully treated with laparoscopy. The first patient was treated 1 year after a stab wound and the second one 10 years after a firearm injury.
In both cases, the diaphragmatic defects were easily laparoscopically detected and treated. The defects were repaired with a direct running suture owing to the acceptable dimensions of the tears. The mean operative time was 135 minutes (range, 75-195). The blood loss during the operations was unremarkable. No intraoperative complications occurred, and the conversion rate was null. The postoperative course was uneventful in the first patient, whereas the second patient, owing to the intraoperative respiratory problems, needed an accurate respiratory monitoring in the Intensive Care Unit. The mean length of stay after the operation was 7 days (range, 6-8). At follow-up, the clinical examination and the chest X-rays documented no recurrence.
We recommend the use of laparoscopy in left chronic TDH repair, performing a direct suture of the diaphragm when possible.
创伤性膈疝（TDH）可在钝性或穿透性创伤后急性出现，也可能多年未被发现。关于腹腔镜修补术在急性和慢性TDH中的应用存在争议。
在本文中，我们介绍了两例成功通过腹腔镜治疗的慢性TDH病例。第一例患者在刺伤后1年接受治疗，第二例在火器伤后10年接受治疗。
在这两例病例中，腹腔镜下均能轻松检测并治疗膈肌缺损。由于裂口尺寸可接受，采用连续直接缝合修复缺损。平均手术时间为135分钟（范围75 - 195分钟）。术中失血不明显。未发生术中并发症，中转率为零。第一例患者术后过程顺利，而第二例患者由于术中出现呼吸问题，在重症监护病房需要进行精确的呼吸监测。术后平均住院时间为7天（范围6 - 8天）。随访时，临床检查和胸部X线检查均未发现复发。
我们建议在左慢性TDH修补术中使用腹腔镜，尽可能对膈肌进行直接缝合。
