腹腔镜治疗陈旧性创伤性膈疝的初步探讨

Clinical Evaluation of Laparoscopic Repair of Delayed Traumatic Diaphragmatic Hernia

目的探讨腹腔镜手术治疗陈旧性创伤性膈疝的安全性和有效性。方法回顾分析2011年3月~2014年2月我院收治陈旧性创伤性膈疝5例资料,男3例,女2例,年龄20~47岁,中位年龄36岁。车祸伤4例,高空坠落伤1例。术前均经CT确诊。采用腹腔镜手术,还纳疝入的腹腔器官,采用不可吸收线间断缝合修补膈肌缺损,4例缺损无法缝合修补,采用补片修补。结果 5例手术均成功实施,手术时间74~210 min,平均135 min;手术出血量10~70 ml,平均24 ml;术后住院时间4~8 d,平均6 d。随访3~36个月,平均19.5月,未发现膈疝复发。结论腹腔镜治疗陈旧性创伤性膈疝具有创伤小、术后恢复快、术后并发症少等优点,是治疗创伤性膈疝的有效手术方式。

Objective To explore the safety and efficacy of laparoscopic repair of delayed traumatic diaphragmatic hernia.Methods Clinical data of 5 patients with delayed traumatic diaphragmatic hernia receiving laparoscopic treatment from March 2011 to February 2014 were retrospectively analyzed. There were 3 males and 2 females,aged from 20- 47（ medium,36） years old. Four patients had a car accident and one was injured by falling. They were all diagnosed by CT and repaired under laparoscopy. The abdominal organs were pulled back through diaphragmatic defect which was then repaired with interrupted non-absorbable sutures or mesh. Results Five patients were all repaired by laparoscopy successfully. The operating time ranged from 74 to 210 minutes with an averaged of 135 minutes. The amount of blood loss ranged from 10 to 70 ml with an average of 24 ml. The mean duration of hospitalization after operation was 6 days（ 4- 8 days）. Follow-up for 3- 36 months（ mean,19. 5 months） found no severe postoperative complications or recurrence. Conclusion Laparoscopic repair of delayed traumatic diaphragmatic hernia has advantages of minimal invasion,quick recovery,and less complications,being an effective option for the treatment of traumatic diaphragmatic hernia.