Takiuchi Hiroki, Totsugawa Toshinori, Tamaki Takahiko, Kuinose Masahiko, Yoshitaka Hidenori, Tsusima Yoshimasa
Departments of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-1-10 Marunouchi, Kita-ku, Okayama, Japan.
Ann Thorac Cardiovasc Surg. 2011;17(6):624-7. doi: 10.5761/atcs.cr.11.01666. Epub 2011 Aug 17.
Surgeons should be aware of diaphragmatic hernia in obese patients who have undergone coronary artery bypass grafting (CABG) using a gastroepiploic artery graft (GEA), even if the antegastric route is utilized.We report a case of diaphragmatic hernia, which occurred 88 months after initial CABG. A 64-year-old obese man underwent surgical repair of a diaphragmatic hernia. At initial surgery, the diaphragm was incised vertically and re-sutured, leaving a route for GEA graft. Both the stomach and the lateral segment of the liver were dislocated in the pericardial space. The diaphragmatic defect was closed with a polytetrafluoroethylene patch.
外科医生应意识到，对于接受过使用胃网膜动脉移植物（GEA）进行冠状动脉旁路移植术（CABG）的肥胖患者，即使采用经胃前途径，也可能发生膈疝。我们报告一例膈疝病例，该病例在初次CABG术后88个月发生。一名64岁肥胖男性接受了膈疝手术修复。初次手术时，垂直切开膈肌并重新缝合，为GEA移植物留出一条路径。胃和肝外侧段均移位至心包腔。用聚四氟乙烯补片封闭膈肌缺损。
