Esposito Francesco, Lim Chetana, Salloum Chady, Osseis Michael, Lahat Eylon, Compagnon Philippe, Azoulay Daniel
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France.
INSERM, U955, Créteil, France.
Ann Hepatobiliary Pancreat Surg. 2017 Aug;21(3):114-121. doi: 10.14701/ahbps.2017.21.3.114. Epub 2017 Aug 31.
BACKGROUNDS/AIMS: Postoperative diaphragmatic hernia, following liver resection, is a rare complication.
Data of patients who underwent major hepatectomy for liver tumors, between 2011 and 2015 were retrospectively reviewed. The literature was searched for studies reporting the occurrence of diaphragmatic hernia following liver resection.
Diaphragmatic hernia developed in 2.3% of patients (3/131) with a median delay of 14 months (4-31 months). One patient underwent emergency laparotomy for bowel obstruction and two patients underwent elective diaphragmatic hernia repair. At last follow-up, no recurrences were observed. Fourteen studies including 28 patients were identified in the literature search (donor hepatectomy, n=11: hepatectomy for liver tumors, n=17). Diaphragmatic hernia was repaired emergently in 42.9% of cases and digestive resection was necessary in 28.5% of the cases. One patient died 3 months after hepatectomy, secondary to sepsis, from a segment of small bowel that perforated into the diaphragmatic hernia.
Although rare, diaphragmatic hernia should be considered as an important complication, especially in living donor liver transplant patients. Diaphragmatic hernia should be repaired surgically, even for asymptomatic patients.
背景/目的：肝切除术后膈疝是一种罕见的并发症。
回顾性分析2011年至2015年间因肝肿瘤接受大肝切除术患者的数据。检索文献，查找报告肝切除术后膈疝发生情况的研究。
2.3%的患者（3/131）发生膈疝，中位延迟时间为14个月（4 - 31个月）。1例患者因肠梗阻接受急诊剖腹手术，2例患者接受择期膈疝修补术。末次随访时，未见复发。文献检索共纳入14项研究，包括28例患者（供体肝切除术，n = 11；肝肿瘤肝切除术，n = 17）。42.9%的病例急诊行膈疝修补术，28.5%的病例需要行消化道切除术。1例患者肝切除术后3个月因败血症死亡，原因是一段小肠穿孔进入膈疝。
尽管膈疝罕见，但应将其视为一种重要并发症，尤其是在活体肝移植患者中。即使是无症状患者，膈疝也应行手术修补。
