Nakashima Shinji, Watanabe Atsushi, Hashimoto Makoto, Mishina Taijirou, Obama Takuro, Higami Tetsuya
Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan.
Ann Thorac Cardiovasc Surg. 2011;17(2):185-9. doi: 10.5761/atcs.cr.09.01528.
Adults who have undergone surgical repair of congenital diaphragmatic hernia have a prolonged illness. They usually have severe adhesions around the intrathoracic hernial sac; therefore, the adhesion itself as well as misidentification of the hernial defect can make surgical repair difficult, even in open surgery. Here, we present the successful video-assisted thoracoscopic surgical repairs of Bochdalek and Morgagni hernias in patients with severe adhesions of the hernial sac (peritoneum) to the parietal pleura lying over the thoracic wall and diaphragm. An 18-year-old woman with a Bochdalek hernia and a 28-year-old woman with a Morgagni hernia underwent thoracoscopic division of severe adhesions, proper minithoracotomy, and precise repairs of diaphragmatic defects. Postoperative courses of both patients were uneventful with no signs of recurrence of the hernia. Thus, we recommend the thoracoscopic approach as the first choice over an open or laparoscopic approach in the management of adult patients with Bochdalek or Morgagni hernias and severe adhesion.
接受过先天性膈疝手术修复的成年人病程较长。他们通常在胸腔内疝囊周围有严重粘连；因此，粘连本身以及疝缺损的误认都会使手术修复变得困难，即使是在开放手术中。在此，我们展示了在疝囊（腹膜）与覆盖胸壁和膈肌的壁层胸膜严重粘连的患者中，成功通过电视辅助胸腔镜手术修复波氏孔疝和莫氏孔疝。一名患有波氏孔疝的18岁女性和一名患有莫氏孔疝的28岁女性接受了胸腔镜下严重粘连分离、适当的小切口开胸术以及膈肌缺损的精确修复。两名患者的术后病程均顺利，无疝复发迹象。因此，我们建议在治疗患有波氏孔或莫氏孔疝且有严重粘连的成年患者时，胸腔镜手术应作为首选，优于开放手术或腹腔镜手术。
