Roy A, Lapointe R, Dagenais M, McAlister V, Grant D R, Brown W, Hutton L, Wall W J
Département de Chirurgie Hépato-Biliaire et Pancréatique, Hôpital Saint-Luc, Université de Montréal, Québec.
Ann Chir. 1993;47(9):810-5.
Right hemidiaphragm paralysis has been previously documented in patients after orthotopic liver transplantation (OLT) and it may contribute to the development of postoperative pulmonary problems. It has been postulated that a crush injury to the right phrenic nerve during OLT is the cause of dysfunction of the right hemidiaphragm. To assess the incidence and effect of right phrenic nerve injury after OLT, we prospectively studied 51 adult liver recipients that we compared with twelve patients who underwent liver resection (LR) without suprahepatic vena cava clamping. We studied the diaphragm excursion by ultrasound, the pulmonary function tests and the transcutaneous phrenic nerve conduction. Righ phrenic nerve injury and hemidiaphragm paralysis occurred respectively in 79% and 38% of the liver recipients but not after LR. Conduction along the right phrenic nerve was absent in 53% of the patients and reduced in another 26%. Left phrenic nerve conduction and left hemidiaphragm excursion were normal in both groups. Liver recipients with no conduction in the right phrenic nerve had a significantly greater decrease in vital capacity in the supine position compared to those with some conduction (29% vs 14%; P < 0.001). However, neither the time on the ventilator or the hospital stay were significantly different between the two groups. Complete recovery of phrenic nerve conduction and diaphragm function may take up to nine months. Right phrenic nerve injury is common after OLT and causes right hemidiaphragm dysfunction.
右半膈肌麻痹先前已在原位肝移植（OLT）患者中得到记录，它可能导致术后肺部问题的发生。据推测，OLT期间右膈神经受到挤压伤是右半膈肌功能障碍的原因。为了评估OLT后右膈神经损伤的发生率和影响，我们前瞻性地研究了51例成年肝移植受者，并将其与12例未进行肝上腔静脉钳夹的肝切除术（LR）患者进行比较。我们通过超声、肺功能测试和经皮膈神经传导来研究膈肌活动度。肝移植受者中右膈神经损伤和半膈肌麻痹的发生率分别为79%和38%，而LR患者中未出现此类情况。53%的患者右膈神经传导消失，另有26%的患者传导减弱。两组患者的左膈神经传导和左半膈肌活动度均正常。与有一定传导的患者相比，右膈神经无传导的肝移植受者仰卧位时肺活量的下降幅度明显更大（29%对14%；P<0.001）。然而，两组患者的机械通气时间和住院时间均无显著差异。膈神经传导和膈肌功能的完全恢复可能需要长达九个月的时间。OLT后右膈神经损伤很常见，并会导致右半膈肌功能障碍。
