Division of Thoracic Surgery, Swedish Medical Center, Suite 850, 1101 Madison Street, Seattle, WA 98104, USA.
Thorac Surg Clin. 2009 Nov;19(4):491-500. doi: 10.1016/j.thorsurg.2009.08.001.
Chronic traumatic diaphragmatic hernia is an uncommon but persistent diagnosis associated with significant morbidity and mortality. Chronic TDH describes a spectrum of disease in antecedent mechanism of injury, timing of presentation, size of diaphragmatic defect, and amount and type of tissue displaced into the chest. Multiplanar CT with coronal, sagittal, and axial reconstruction is most effective in making this diagnosis. Once diagnosed, repair should be undertaken. Although transabdominal approaches may be successful, the authors prefer an open transthoracic approach, recognizing that either approach may need to incorporate access into the other body cavity to complete the repair. Basic hernia principles apply including the construction of a tension-free repair, which may necessitate the use of prosthetics. As surgeons become increasingly comfortable with minimally invasive techniques, more chronic TDH are likely to be approached in this fashion. Finally, as much of the morbidity and mortality is associated with the catastrophic consequences of chronic TDH, vigilance needs to be applied in an attempt to diagnose and then repair TDH while in the latent stage prior to the development of the catastrophic complications that herald the obstructive stage.
慢性创伤性横膈疝是一种不常见但持续存在的诊断，与显著的发病率和死亡率相关。慢性 TDH 描述了一系列疾病，包括损伤的先前机制、表现的时间、横膈膜缺陷的大小，以及进入胸腔的组织的数量和类型。多平面 CT 结合冠状位、矢状位和轴位重建是做出这一诊断的最有效方法。一旦确诊，就应该进行修复。虽然经腹入路可能成功，但作者更喜欢开胸经胸入路，认识到任何一种入路都可能需要进入另一个体腔来完成修复。基本的疝原则适用，包括构建无张力修复，这可能需要使用假体。随着外科医生对微创技术越来越熟悉，更多的慢性 TDH 可能会以这种方式进行治疗。最后，由于大部分发病率和死亡率与慢性 TDH 的灾难性后果相关，因此需要保持警惕，试图在横膈膜疝处于潜伏阶段，即在出现预示阻塞阶段的灾难性并发症之前，诊断并修复 TDH。
