Bruen Kevin, Downey Earl
Department of Surgery, Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah 84113, USA.
J Laparoendosc Adv Surg Tech A. 2007 Jun;17(3):383-6. doi: 10.1089/lap.2006.0059.
A successful placement of a transabdominal pericardial window is associated with diaphragmatic hernia. In this paper, we present the case of a 5-month-old ex-31-weeks-premature baby who developed a symptomatic diaphragmatic hernia following a chronic pericardial effusion who was treated successfully with a laparoscopic transabdominal pericardial window. Laparoscopy and a pericardial window were used to manage the symptomatic effusion that developed following a bilateral thoracotomy and median sternotomy for the patient's massive hygroma. The patient was followed before and after pericardial drainage with a serial examination, chest radiography, and echocardiography. In addition, computerized tomography was also used for long-term follow-up following the repair of the hernia. An acellular dermal matrix was utilized for patching the hernia with a laparotomy. The abdominal approach in both operations offered direct access to the pericardial space and hernia, thereby avoiding previously operated thoraces. A subsequent follow-up at 9 months following the creation of the window suggested a recurrent tamponade physiology. Plain radiographs and an echocardiogram showed herniation into the pericardial sac. The hernia was operatively reduced and repaired with an acellular dermal matrix. Recovery and subsequent followup at 1 year revealed no hernia, full symptom resolution, and no recurrence of the pericardial effusion. A pericardial window is an effective approach for the management of chronic pericardial effusion. Diaphragmatic herniation through a pericardial window can be successfully repaired with an acellular dermal matrix.
经腹心包开窗术成功实施后可能并发膈疝。本文报告了一例5个月大、孕31周早产的婴儿，该患儿在慢性心包积液后出现有症状的膈疝，经腹腔镜经腹心包开窗术成功治疗。腹腔镜检查和心包开窗术用于处理该患儿因巨大淋巴管瘤行双侧开胸术和正中胸骨切开术后出现的有症状积液。在进行心包引流前后，对患儿进行了系列检查、胸部X线摄影和超声心动图检查。此外，在疝修补术后还使用计算机断层扫描进行长期随访。采用脱细胞真皮基质通过剖腹术修补疝。这两种手术的腹部入路都能直接进入心包腔和疝，从而避免了先前手术过的胸腔。在开窗术后9个月的后续随访中发现有复发性心脏压塞表现。X线平片和超声心动图显示疝入心包囊。通过手术将疝回纳并用脱细胞真皮基质进行修补。术后1年的恢复情况及后续随访显示无疝复发，症状完全缓解，心包积液未复发。心包开窗术是治疗慢性心包积液的有效方法。通过心包开窗形成的膈疝可用脱细胞真皮基质成功修补。
