Cetinkaya Ayse, Zeriouh Mohamed, Liakopoulos Oliver-Joannis, Hein Stefan, Siemons Tamor, Bramlage Peter, Schönburg Markus, Choi Yeong-Hoon, Richter Manfred
Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany.
Department of Radiology, Kerckhoff-Heart Center, Bad Nauheim, Germany.
J Surg Case Rep. 2020 Nov 10;2020(11):rjaa415. doi: 10.1093/jscr/rjaa415. eCollection 2020 Nov.
Minimally invasive cardiac surgery (MICS) via right lateral mini thoracotomy is the gold standard treatment approach for mitral and tricuspid valve disorders. Other selected procedures (e.g. transapical aortic valve implantation, MIDCAB) require a left lateral mini thoracotomy for surgical access. Advantages of MICS over complete sternotomy are well known, but access-related complications post MICS, such as pulmonary herniation, are often underestimated/overlooked. In males, a pulmonary herniation in the proximity of the former thoracotomy is often clinically visible, especially when the intrathoracic pressure rises (e.g. during coughing). In females, clinical symptoms may be hidden by the breast and patients often have unspecific complaints or occasional pain when coughing, making identification of a lung herniation more difficult. Chest computed tomography is the diagnostic tool of choice for pulmonary herniations. Using a series of 20 patients with pulmonary herniation post MICS, we report our findings in diagnosis and treatment of this condition.
经右侧微创开胸的微创心脏手术（MICS）是二尖瓣和三尖瓣疾病的金标准治疗方法。其他特定手术（如经心尖主动脉瓣植入术、微创冠状动脉搭桥术）需要左侧微创开胸以获得手术入路。MICS相对于完全胸骨切开术的优势是众所周知的，但MICS术后与手术入路相关的并发症，如肺疝，常常被低估或忽视。在男性中，既往开胸部位附近的肺疝在临床上通常可见，尤其是当胸腔内压力升高时（如咳嗽时）。在女性中，临床症状可能被乳房掩盖，患者通常有非特异性主诉或咳嗽时偶尔疼痛，这使得肺疝的识别更加困难。胸部计算机断层扫描是诊断肺疝的首选工具。我们报告了对20例MICS术后发生肺疝患者的诊断和治疗结果。
