电视胸腔镜手术治疗创伤性膈疝

Video-assisted Thoracoscopic Surgery for Traumatic Diaphragmatic Hernia

目的探讨电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)在创伤性膈疝治疗中的应用价值。方法 2005年12月～2011年12月对27例创伤性膈疝行VATS膈疝回纳联合膈肌修补术。术中探查损伤情况,分离粘连并止血后,将膈疝回纳入腹腔,丝线8字缝合后prolene线加固缝合膈肌裂口。出血、裂伤脏器行修补或切除,损伤严重者中转开胸探查。结果 26例术后均恢复顺利,好转或痊愈出院,1例因病情严重术中死亡。5例中转开胸,其余21例均在VATS下完成手术,中转率18.5%(5/27)。手术时间45～190 min,平均135 min;术中出血量20～680 ml,平均278 ml。术后胸腔引流2～5 d,平均3.5 d;引流量30～280 ml,平均185 ml。术中、术后无并发症。术后住院时间2～10 d,平均6.5 d。26例随访1～24个月,平均12.5月,无并发症发生。结论 VATS治疗创伤性膈疝可行、安全。

Objective To study the efficacy of video-assisted thoracoscopic surgery （VATS） in the traumatic diaphragmatic hernia. Methods A retrospective review of 27 patients with traumatic diaphragmatic hernia, who received VATS for diaphragmatic hernia retroposition ＋ diaphragmatic muscle prosthesis between December 2005 and December 2011. After separating the adhesive tissues and controlling hemorrhage, the hernia was returned back to the abdominal cavity, and then with the ruptured diaphragm being repaired with prolene suture, and then injured organs were resected or repaired. For severe injuries, open surgery was carried out for further exploration. Results All the patients recovered well after the procedure, except for one, who died during the VATS. Five patients were converted to open surgery [ conversion rate ： 18.5 % （5/27） ]. The mean operation time was 135 min （ ranged from 45 to 190 min）, and intraoperative blood loss was 278 ml in average （20 -680 ml）. The mean duration of chest drainage was 3.5 d （2 -5 d）, and the mean drainage volume was 185 ml （30- 280 ml）. No intra- or postoperative complications occurred. The mean postoperative hospital stay was 6.5 d （2 - 10 d）. The patients were followed up for 1 to 24 months with a mean of 12.5 months, during which no complications were reported. Conclusion VATS is feasible and safe for traumatic diaphragmatic hernia.