Amer Khalid
The Cardiovascular & Thoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK.
J Vis Surg. 2017 Nov 30;3:176. doi: 10.21037/jovs.2017.10.05. eCollection 2017.
Congenital diaphragmatic hernias (CDH) are likely to present in early postnatal or infancy and are associated with significant morbidity and mortality due to associated pulmonary hypoplasia, pulmonary hypertension and heart failure. Symptomatic adult congenital Bochdalek hernia, on the other hand, is extremely rare with a prevalence of 0.17-6% of all diaphragmatic hernias. They present with recurrent abdominal pain and shortness of breath. Acute presentations could be life threatening especially if there is incarcerated or threatened bowel in the chest. Repair of symptomatic Bochdalek hernia is recommended in the adult population. We present two cases of right and left symptomatic Bochdalek hernias in adults, encountered over 15 years of practice in a tertiary referral centre in the UK. We discuss their presentation and surgical management and review the literature of similar cases treated by video-assisted thoracoscopic surgery (VATS). Thoracic surgeons are increasingly becoming involved in these cases, which used to be the domain of upper gastrointestinal surgeons. A synthetic patch may be required to close the defect, therefore; the thoracic surgeon must be familiar with such techniques. The recent expansion in video format publishing in the internet and social media has revolutionized the way knowledge and how-to-do-it expertise is distributed around the world. It has the advantage of reaching far more viewer than subscription paper-printed format journals and has a rising significance in encouraging thoracic surgeons to do things they were not used to do. Finally; Symptomatic Bochdalek hernia, and possibly Morgagni hernia in the adult population could be safely repaired by VATS with good and lasting results.
先天性膈疝（CDH）往往在出生后早期或婴儿期出现，由于合并肺发育不全、肺动脉高压和心力衰竭，其发病率和死亡率都很高。另一方面，有症状的成人先天性博赫达勒克疝极为罕见，在所有膈疝中占比0.17%-6%。其症状表现为反复腹痛和呼吸急促。急性发作可能危及生命，尤其是当胸腔内出现嵌顿或有绞窄风险的肠管时。建议对成年患者的有症状博赫达勒克疝进行修补。本文介绍了在英国一家三级转诊中心15年的诊疗实践中遇到的两例成人左右侧有症状博赫达勒克疝病例。我们讨论了其临床表现和手术治疗方法，并回顾了通过电视辅助胸腔镜手术（VATS）治疗类似病例的文献。过去这类病例属于上消化道外科医生的范畴，如今胸外科医生越来越多地参与其中。因此，可能需要使用合成补片来闭合缺损；胸外科医生必须熟悉此类技术。近年来，互联网和社交媒体上视频形式的出版物激增，彻底改变了知识以及实际操作专业技能在全球的传播方式。与订阅纸质期刊相比，视频形式能触及更多的观众，在鼓励胸外科医生开展他们不熟悉的手术方面，其重要性日益凸显。最后；有症状的博赫达勒克疝，以及成人中的莫尔加尼疝，通过VATS可以安全修复，效果良好且持久。
