Filosso Pier Luigi, Guerrera Francesco, Sandri Alberto, Lausi Paolo Olivo, Lyberis Paraskevas, Bora Giulia, Roffinella Matteo, Ruffini Enrico
Unit of Thoracic Surgery, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Torino, Torino, Italy.
Unit of Thoracic Surgery, Department of Oncology, San Luigi Gonzaga Hospital, University of Torino, Torino, Italy.
J Thorac Dis. 2019 Feb;11(Suppl 2):S177-S185. doi: 10.21037/jtd.2019.01.54.
Chronic diaphragmatic hernia (CDH) is an uncommon disease which may be associated with significant morbidity and mortality. Antecedent (even many months or years before CDH development) blunt or penetrating thoracic/thoraco-abdominal trauma is generally recognized. A wide spectrum of different mechanisms of injury, timing in presentation, size of the diaphragmatic defect, types and amount of abdominal viscera herniated into the chest cavity, clinical symptoms are observed in CDHs. Thoracic and abdominal CT scan (with coronal, axial and sagittal reconstructions) is the best diagnostic tool; sometimes thoracic MRI is needed to better define the extent of the diaphragmatic defect and the number of abdominal organs displaced into the chest cavity. Surgery (sometimes urgent) represents the treatment of choice for CDH; diaphragmatic hernia direct repair with a tension-free suture is generally attempted; in case of very large defects or when a tension-free suture is deemed unfeasible, the use of prosthesis is recommended. This review article will discuss about CDH aetiology, clinical presentation diagnosis and surgical treatment.
慢性膈疝（CDH）是一种罕见疾病，可能伴有显著的发病率和死亡率。一般认为，在CDH发生之前（甚至在其发生前数月或数年）有钝性或穿透性胸/胸腹外伤史。在CDH中可观察到广泛不同的损伤机制、出现时间、膈缺损大小、疝入胸腔的腹腔脏器类型和数量以及临床症状。胸部和腹部CT扫描（包括冠状位、轴位和矢状位重建）是最佳诊断工具；有时需要进行胸部MRI以更好地确定膈缺损的范围和移入胸腔的腹部器官数量。手术（有时为急诊手术）是CDH的首选治疗方法；通常尝试用无张力缝合直接修复膈疝；对于非常大的缺损或当无张力缝合不可行时，建议使用假体。这篇综述文章将讨论CDH的病因、临床表现、诊断和手术治疗。
