Đang chuẩn bị liên kết để tải về tài liệu:
Difficult Decisions in Thoracic Surgery - part 8

Nó thường tin rằng một chấn thương dây thần kinh cơ hoành phức tạp phẫu thuật tim ở trẻ em, nếu được công nhận cuộc phẫu thuật, nên nhắc nhở sự quăn lại ngay lập tức thông qua sternotomy.1, 13 là không có sự đồng thuận hoặc các dữ liệu đầy đủ về sự quăn lại trong những trường hợp tương tự như ở người lớn. | 360 M. Alifano 44.2. Surgical Technique Morrison published a report of the first surgical repair in 19 2 3.22 Since this initial description different surgical techniques have been proposed. Plication can be carried out by thoracic or abdominal access open surgery or video-assisted techniques have been proposed. 44.2.1. Open Approaches It is generally believed that a phrenic nerve injury complicating cardiac surgery in children if recognized intraoperatively should prompt immediate plication through the sternotomy.1 13 There is no consensus or sufficient data about plication in similar circumstances in adults. In any other setting sternotomy is obviously not an option. A midline laparotomy has been employed in cases of bilateral diaphragmatic elevation or infracardiac involvement although such an approach is occasionally employed in case of pure unilateral diaphragmatic elevation.1 The exception is represented by patients with diaphragmatic eventration associated with an intraabdominal disease requiring surgery. In these cases laparotomy is adequate in dealing with both conditions.23 Transthoracic plication has been generally performed by a standard posterolateral thoracotomy. Simple plication is generally employed because it is faster and avoids entry into the peritoneal cavity. The technique described by Schwartz and Filler24 sometimes slightly modified is usually employed the slack portion of the diaphragm is pulled in a radial direction and pleats are created by full-thickness nonabsorbable mattress sutures. The surgeon should aim at repositioning the dome of the diaphragm one or two intercostal spaces below where it should ultimately be located. The more frequently employed alternative technique is represented by resection of the excess aponeurotic portion of the diaphragm with a two-layer overlapping approximation of peripheral muscle. This technique offers the advantage of avoiding inadvertent injury to abdominal organs but it involves the frequent section .