心室辅助装置植入术后胸腔镜下膈疝修补术
Thoracoscopic repair of diaphragmatic hernia following ventricular assist device implantation.
作者信息
Saka Ryuta, Sakai Takaaki, Kanaya Tomomitsu, Tazuke Yuko, Kugo Yosuke, Taira Masaki, Ueno Takayoshi, Okuyama Hiroomi
机构信息
Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
出版信息
Surg Case Rep. 2020 Jul 11;6(1):170. doi: 10.1186/s40792-020-00933-7.
BACKGROUND
Diaphragmatic hernia is a rare complication of ventricular assist device (VAD), mainly developing after explantation of the device. We herein report a case of diaphragmatic hernia that developed following the implantation of VAD.
CASE PRESENTATION
A 4-month-old girl with a diagnosis of dilated cardiomyopathy underwent VAD implantation for a bridge to heart transplantation. Three months later, intermittent vomiting developed, and left-sided diaphragmatic hernia was confirmed on plain X-ray and computed tomography. Without any findings of ischemia, we performed elective thoracoscopic repair of the diaphragmatic hernia. In the right decubitus position, thoracoscopy revealed the small intestine to be herniated into the left thorax. After reduction of the herniated intestine, the defect of the diaphragm (3 × 2 cm in size) was directly closed with interrupted non-absorbable sutures. Her postoperative course was uneventful.
CONCLUSION
Thoracoscopic repair of diaphragmatic hernia associated with VAD implantation may be a safe approach.
背景
膈疝是心室辅助装置（VAD）的一种罕见并发症，主要在装置移除后发生。我们在此报告一例VAD植入后发生的膈疝病例。
病例介绍
一名4个月大诊断为扩张型心肌病的女孩接受VAD植入作为心脏移植的过渡治疗。三个月后，出现间歇性呕吐，胸部X线平片和计算机断层扫描证实为左侧膈疝。在没有任何缺血表现的情况下，我们对膈疝进行了择期胸腔镜修补术。在右侧卧位时，胸腔镜检查发现小肠疝入左胸腔。将疝入的肠管复位后，用间断不可吸收缝线直接缝合膈肌缺损（大小为3×2 cm）。她的术后过程顺利。
结论
胸腔镜修补与VAD植入相关的膈疝可能是一种安全的方法。
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