Cloutier R, Fournier L, Major D, Béland L, Péloquin J, Poncelet P
Service de Chirurgie Pédiatrique et d'Anesthésie, Centre Hospitalier de l'Université Laval, Sainte-Foy, Québec, Canada.
Chir Pediatr. 1989;30(1):6-9.
Twenty-eight patients with "High-Risk" diaphragmatic hernia were treated without postoperative ipsilateral chest drains. Overall survival was 71%. This study suggests that, in cases of complete absence of the diaphragm, the use of a mesh pervious to air is as noxious postoperatively as an underwater chest drain. This idea is supported by experiments in cats with a left pneumonectomy, in which part of the diaphragm was replaced either by a macroporous mesh or by a microporous prosthesis impervious to air at normal pressures. Moreover, barotrauma may occur preoperatively and when assisted ventilation is required, inspiratory pressure must be strictly limited.
28例“高危”膈疝患者在术后未留置同侧胸腔引流管。总体生存率为71%。本研究表明，在完全没有膈肌的情况下，使用透气网片在术后与水下胸腔引流管一样有害。这一观点得到了猫左肺切除实验的支持，在该实验中，部分膈肌被大孔网片或常压下不透气的微孔假体所替代。此外，气压伤可能在术前发生，当需要辅助通气时，吸气压力必须严格限制。
