Kurzel R B, Naunheim K S, Schwartz R A
Department of Obstetrics and Gynecology, St. Mary's Health Center, St. Louis, Missouri.
Obstet Gynecol. 1988 Jun;71(6 Pt 1):869-71.
Congenital diaphragmatic hernia complicating pregnancy is a rarity, accounting for only six out of 17 cases of diaphragmatic hernia reported in the English literature. This case report describes the first successful repair of an acutely symptomatic foramen of Bochdalek hernia during pregnancy, with maternal and fetal survival. In the asymptomatic patient, surgery should be performed promptly on an elective basis in the first and second trimesters. During the third trimester, an asymptomatic defect should be repaired at the time of elective cesarean section. Active labor should be avoided. If symptoms of obstruction arise, this lesion represents a true surgical emergency, and immediate operative intervention should be undertaken regardless of the stage of pregnancy. Delay can result in both fetal and maternal mortality in up to half of cases. Tube gastrostomy may be performed at the time of repair to avert a potential prolonged gastric ileus and gastric volvulus.
先天性膈疝合并妊娠实属罕见，在英文文献报道的17例膈疝病例中仅占6例。本病例报告描述了首例成功修复孕期急性症状性Bochdalek孔疝，母婴均存活。对于无症状患者，应在孕早期和孕中期择期及时进行手术。在孕晚期，无症状缺损应在择期剖宫产时修复。应避免活跃分娩。如果出现梗阻症状，此病变是真正的外科急症，无论妊娠处于何阶段均应立即进行手术干预。延误可能导致高达半数病例出现母婴死亡。修复时可进行胃造瘘术，以避免可能出现的长期胃麻痹和胃扭转。
