RESUMO
Blunt chest trauma followed by diaphragm rupture is a severe injury requiring surgical correction both in acute and long-term periods. Posttraumatic diaphragmatic hernia is dangerous by infringement of dislocated organs. Thanks to adaptive mechanisms of the organism, patients with non-functioning half of the diaphragm have a good quality of life for a long time. Symptoms (respiratory disorders and arrhythmia, predominantly) occur over time in patients with concomitant diseases and impaired function of vital organs. At the same time, simultaneous thoracic and abdominal surgery is possible. Thoracotomy is advisable for injury of the right half of the diaphragm, thoracotomy and laparotomy - for injury of the left half. It is presented case report of diaphragm repair by primary suture without application of strengthening materials in 17 years after complex trauma. In this case, diaphragm function was restored that resulted improved quality of life.
Assuntos
Diafragma/lesões , Diafragma/cirurgia , Hérnia Diafragmática Traumática/cirurgia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Hérnia Diafragmática Traumática/diagnóstico , Hérnia Diafragmática Traumática/etiologia , Humanos , Laparotomia , Qualidade de Vida , Ruptura , Técnicas de Sutura , ToracotomiaRESUMO
AIM: To clarify the indications for reconstructive surgery in patients with diaphragmatic hernia. MATERIAL AND METHODS: Retrospective trial has included 36 patients with diaphragmatic hernia for the period 1963-2017. There were 23 (63.9%) women and 13 (36.1%) men. The majority of patients (83%) underwent surgery at able-bodied age (18-60 years). 27 (75%) patients had hernia of weak diaphragmatic zones, 9 (25%) - posttraumatic hernia. Diaphragm repair was performed with primary suture. In 2 cases of posttraumatic hernia mesh endoprosthesis was used. RESULTS: All patients were discharged. Postoperative complications arose in 4 (11.1%) patients, including 2 cases of mesh endoprosthesis deployment. Long-term outcome was followed-up in 15 patients from 6 months to 17 years. Recurrent hernia was absent in all cases. CONCLUSION: Primary suture is acceptable for diaphragmatic hernia repair. Alloplastic repair is indicated for large defect, when primary suture is impossible or risk of its failure is high.
Assuntos
Hérnia Diafragmática/cirurgia , Adolescente , Adulto , Feminino , Hérnia Diafragmática/etiologia , Hérnia Diafragmática Traumática/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Implantação de Prótese , Estudos Retrospectivos , Telas Cirúrgicas , Adulto JovemRESUMO
AIM: To develop examination algorithm and to determine the indications for various options for surgical treatment. MATERIAL AND METHODS: It is presented analysis of surgical treatment of 25 patients with unilateral diaphragm relaxation for the period from 1963 to 2016. There were 15 men and 10 women aged from 39 to 65 years. Diagnosis included predominantly radiological methods. All patients were operated openly through thoracotomy. Procedure consisted of creation of new diaphragmatic cupola at the usual level with two flaps of diaphragm and prosthesis between them. In 12 (48%) patients who were operated before 1990 xenopericardial patch was used. Further, synthetic materials (Teflon, polypropylene) were preferred. RESULTS: Postoperative morbidity and mortality was 20% (n=6) and 4% (n=1) respectively. Long-term results were followed-up within terms from 8 months to 12 years. Recurrent relaxation was absent. Most of patients had improved dyspnea, increased vital capacity and FEV1 in long-term period. Certain and general values of SF-36 life quality questionnaire were high in long-term postoperative period and similar to those in general population.
Assuntos
Diafragma/cirurgia , Paralisia Respiratória/cirurgia , Adulto , Idoso , Algoritmos , Dispneia/etiologia , Dispneia/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paralisia Respiratória/complicações , Retalhos Cirúrgicos , ToracotomiaAssuntos
Antibacterianos/administração & dosagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Hemotórax , Pleurisia , Infecção da Ferida Cirúrgica , Acinetobacter baumannii/isolamento & purificação , Idoso , Aorta Torácica/patologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Terapia Combinada , Enterobacter cloacae/isolamento & purificação , Feminino , Hemotórax/etiologia , Hemotórax/fisiopatologia , Hemotórax/cirurgia , Humanos , Pleurisia/etiologia , Pleurisia/fisiopatologia , Pleurisia/terapia , Radiografia , Reoperação/métodos , Índice de Gravidade de Doença , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/fisiopatologia , Infecção da Ferida Cirúrgica/cirurgia , Resultado do TratamentoRESUMO
The rigidity of the chest wall, thank to its bone framework, determines the variety of operative access in thoracic surgery, both thoracoscopic and open. The posterior thoracotomy on the bed of the resected rib in ventral decubitus is traditionally but gratuitously rarely used access. The method permits comfortable access to trachea, bifurcation, main bronchi and thoracic esophagus. It can also be used in cases of foregoing thoracothomy. Authors own the experience of 111 cases with the use of posterior thoracotomy in ventral decubitus. The access proved to be preferable for the operations on the membranous part of the trachea and main bronchi, some localizations of thoracic tracheoesophageal fistula. The access suggests fast mobilization of the root of the lung without foregoing pneumolisis, which is important in cases of pleural cavity obliteration after tuberculosis or pleural empyem.