Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Medicine (Baltimore). 2023 Sep 8;102(36):e35117. doi: 10.1097/MD.0000000000035117.
Cases of respiratory dysfunction due to phrenic nerve sacrifice during resection of massive mediastinal tumor have rarely been studied in detail. Diaphragmatic dysfunction in such cases can lead to potentially fatal respiratory and circulatory disturbances. Therefore, timely diagnosis and intervention are important. Conservative rehabilitation therapy is the first choice for respiratory dysfunction due to diaphragmatic dysfunction.
PATIENT CONCERNS, DIAGNOSES AND INTERVENTIONS: We present 3 patients with respiratory dysfunction due to phrenic nerve sacrifice during resection of massive mediastinal tumor. The diagnostic methods and therapeutic procedures for diaphragmatic dysfunction for each patient are described in detail. This study highlights the role of ventilator support combined with physical therapy in the treatment of respiratory dysfunction in such cases. The diagnosis of diaphragmatic dysfunction as well as the risk assessment of phrenic nerve involvement are also discussed. The modalities of ventilator support, including modes and parameters, are listed.
This study provides experiences of diagnosis and treatment of respiratory dysfunction due to phrenic nerve sacrifice during resection of massive mediastinal tumor. Timely diagnosis of diaphragmatic dysfunction primarily relies on clinical manifestations and radiography. Conservative rehabilitation therapy can improve or restore diaphragmatic function in majority of patients, and avert or delay the need for surgical intervention. Preoperative assessment of the risk of phrenic nerve involvement is important in such cases.
在切除巨大纵隔肿瘤时，因膈神经损伤导致呼吸功能障碍的病例鲜有详细研究。此类情况下的膈神经功能障碍可导致潜在致命的呼吸和循环紊乱。因此，及时诊断和干预非常重要。对于膈肌无力导致的呼吸功能障碍，保守康复治疗是首选。
病例概述、诊断和干预：我们报告了 3 例因切除巨大纵隔肿瘤时膈神经损伤导致呼吸功能障碍的患者。详细描述了每位患者的膈肌无力诊断方法和治疗过程。本研究强调了呼吸机支持联合物理治疗在这类病例呼吸功能障碍治疗中的作用。还讨论了膈肌无力的诊断以及膈神经损伤风险评估。列出了呼吸机支持的模式和参数。
本研究提供了切除巨大纵隔肿瘤时因膈神经损伤导致呼吸功能障碍的诊断和治疗经验。膈肌无力的及时诊断主要依赖于临床表现和影像学检查。多数患者的保守康复治疗可改善或恢复膈肌无力，避免或延迟手术干预的需要。此类情况下，术前评估膈神经损伤风险非常重要。
