Division of Thoracic Surgery, Stanford University School of Medicine, Palo Alto, Calif.
Division of Thoracic Surgery, Stanford University School of Medicine, Palo Alto, Calif.
J Thorac Cardiovasc Surg. 2017 May;153(5):1182-1188. doi: 10.1016/j.jtcvs.2016.11.062. Epub 2016 Dec 21.
Surgeons have hesitated to adopt minimally invasive diaphragm plication techniques because of technical limitations rendering the procedure cumbersome or leading to early failure or reduced efficacy. We sought to demonstrate efficacy and durability of our thoracoscopic plication technique using a single running suture.
We retrospectively reviewed patients who underwent our technique for diaphragm plication since 2008. We used a single, buttressed, double-layered, to-and-fro running suture with additional plicating horizontal mattress sutures as needed.
Eighteen patients underwent thoracoscopic plication from 2008 to 2015. There were no operative mortalities and 2 unrelated late deaths. Median hospital stay was 3 days (range, 1-12). Atrial fibrillation occurred in 1 patient (5.5%), pneumonia occurred in 2 patients (11%), reintubation occurred in 1 patient (5.5%), and ileus occurred in 1 patient (5.5%). Of 14 patients with complete follow-up, median follow-up was 29.4 months (range, 3.4-84.7). Significant increases between preoperative and postoperative pulmonary function tests (% predicted values) were found for mean forced expiratory volume in 1 second (73.5% ± 3.5% to 88.8% ± 4.5%, P = .002) and mean forced vital capacity (70.6% ± 3.5% to 82.3% ± 3.5%, P = .002). Preoperative mean Baseline Dyspnea Index was 8.1 ± 0.7. Mean Transitional Dyspnea Index 6 months postoperatively was 7.1 ± 0.6 (moderate to major improvement). Transitional Dyspnea Index at last contact (median 29.4 months postoperatively) was 7.2 ± 0.6 (P = .38). Compared with previously published results, this is at least equivalent.
Thoracoscopic diaphragm plication with a running suture is safe and achieves excellent early and long-term improvements. This addresses technical challenges of tying multiple interrupted sutures by video-assisted thoracoscopic surgery without any apparent compromise to efficacy or durability.
由于技术限制使手术繁琐或导致早期失败或疗效降低，外科医生一直不愿采用微创膈折叠技术。我们旨在证明我们使用单根连续缝线的胸腔镜折叠技术的疗效和耐用性。
我们回顾性分析了 2008 年以来采用我们的技术行膈折叠术的患者。我们使用单根、支撑双层、来回连续缝线，如果需要，还使用额外的折叠水平褥式缝线。
2008 年至 2015 年期间，18 例患者行胸腔镜折叠术。无手术死亡，2 例与手术无关的晚期死亡。中位住院时间为 3 天（范围，1-12 天）。1 例（5.5%）发生心房颤动，2 例（11%）发生肺炎，1 例（5.5%）再次插管，1 例（5.5%）发生肠梗阻。14 例患者获得完整随访，中位随访时间为 29.4 个月（范围，3.4-84.7 个月）。术前和术后肺功能测试（预计值百分比）发现平均用力呼气 1 秒量（73.5%±3.5%至 88.8%±4.5%，P=.002）和平均用力肺活量（70.6%±3.5%至 82.3%±3.5%，P=.002）显著增加。术前平均基线呼吸困难指数为 8.1±0.7。术后 6 个月平均过渡呼吸困难指数为 7.1±0.6（中度至重度改善）。最后一次随访时的过渡呼吸困难指数（中位随访时间 29.4 个月）为 7.2±0.6（P=.38）。与之前发表的结果相比，这至少是等效的。
胸腔镜膈折叠术采用连续缝线是安全的，并可获得极好的早期和长期改善。这解决了通过电视辅助胸腔镜手术结扎多个间断缝线的技术挑战，而不会对疗效或耐用性造成任何明显影响。
