A NEW METHOD OF SURGICAL TREATMENT OF DIAPHRAGM RELAXATION
Introduction. At the heart of the occurrence of relaxation of the diaphragm is a disorder of its innervation, which often occurs in malignant tumors of the mediastinum with germination in the phrenic nerve. With the relaxation of the entire dome of the diaphragm, the active motor ability is completely lost. The diaphragm shifts into the pleural cavity, which leads to a decrease in lung volume, to a restrictive syndrome, and stable hypoxemia. Due to this, the abdominal organs on the left move up, as if into the "pleural cavity", causing heartburn, belching. The clinic intensifies after eating, the patient feels a heartbeat, which indicates a violation of the heart, up to the manifestation of arrhythmia. The surgeon faces the following task: to perform a surgical correction of the dome of the diaphragm, which stops the paradoxical movement of the diaphragm and returns the patient to normal life and profession. Aime: to present the result of the application of a new method of surgical treatment of diaphragm relaxation in the conditions of the Department of Thoracic Surgery "City Hospital No. 5", Barnaul. Materials and methods: a clinical case of relaxation of both domes of the diaphragm, which occurred 13 years after surgery on the mediastinum, is presented. Operations were performed on plastics of both domes of the diaphragm with an interval of 1 year, by the author's method. Results: the location of the synthetic prosthesis between the sheets of the diaphragm and the U-shaped sutures are the optimal choice in patients with relaxation of the entire dome of the diaphragm. In the given clinical example, the use of the author's method of diaphragm relaxation plasty showed good results in the postoperative and long-term period. Conclusions: the described author's method for the treatment of diaphragm relaxation using a synthetic prosthesis between the sheets of the diaphragm and U-shaped sutures gave a good result in the postoperative and long-term period and requires further study on a large number of patients.
Sergey D. Fokeev1, Stanislav Yu. Kapitulin1, Yelena S. Kazantseva2, Elina K. Kapitulina3, Marat K. Syzdykbayev4, Sanzhar G. Khalelov4, Alexei A. Shavrovsky4 1FSBEI «Altai state medical University» Ministry Of Health Of Russia, Department of faculty surgery named after Professor I. I. Neymark and hospital surgery, with a course of surgery of APE, Barnaul c., Russian Federation; 2«Clinic NIITO», Novosibirsk c., Russian Federation; 3KGBUZ "City Hospital №5, Barnaul», Barnaul c., Russian Federation; 4 NCJSC «Semey Medical University», Semey c., Republic of Kazakhstan.
1. Алиев С.А., Рафиев С.Ф., Зейналов Б.М. Диагностика и хирургическое лечение разрывов диафрагмы // Хирургия. 2010. 10: 22—28. 2. Борисов А.Е., Кубачев К.Г., Кукушкин А.В., Заркуа Н.Э., Зайцев Д.А. Диафрагмальные грыжи, диагностика и хирургическое лечение // Вестник хирургииИ.И. Грекова. 2012. 171: 6: 38—42. 3. Дамбаев Г.Ц., Попов А.М., Гюнтер В.Э., Ходоренко В.Н. Аллопластика диафрагмы новыми биологически-адаптированными наноматериалами. ВестникРосздравнадзора. 2011. 1: 51—59. 4. Корымасов Е.А., Чернышев В.Н., Пушкин С.Ю., Бенян А.С. Выбор оперативного доступа в хирургии диафрагмы // Грудная и сердечно-сосудистая хирургия. 2010. 5: 69—71. 5. Паршин В.Д., Паршин В.В., Мирзоян О.С., Степанян А.А. Операции на диафрагме в плановой торакальной хирургии // Хирургия. Журнал им. Н.И. Пирогова. 2013. (8):7-13. 6. Паршин В.Д., Хетагуров М.А. Хирургия релаксации диафрагмы. Хирургия // Журнал им. Н.И. Пирогова. 2018. (3):4-14. 7. Петровский Б.В., Моисеев В.С., Платов И.И. Хирургия некоторых заболеваний диафрагмы // Хирургия. 2000. №7. C. 23-27. 8. Топольницкий Е.Б., Дамбаев Г.Ц., Шефер Н.А., Ходоренко В.Н., Фомина Т.И., Гюнтер В.Э. Замещение пострезекционных дефектов перикарда, диафрагмы, грудной стенки сетчатым имплантатом из никелида титана // Вопросы реконструктивной и пластической хирургии 2012. 15: 1: 14—21. 9. Хетагуров М.А.Реконструктивные операции на диафрагме в плановой торакальной хирургии. Диссертация на соискание учёной степени кандидата медицинских наук. Москва, 2019г.с. 111 10. Aksaka l.E, Erol M.K., Gundogdu F., Cinici O. Animportant cause of dyspnea after coronary artery by passgrafting: phrenic nerveparalysis // Turk Kardiyol Dern Ars. 2009. №37. - P. 132-135. 11. Bekdash B., Singh B., Lakhoo K. Recurrent late complications following congenital diaphragmatic hernia repair with prosthetic patches: a case series // Journal of Medical Case Reports. 2009. №3, №7237. 12. Deng Y., Byth K., Paterson H.S. Phrenic nerve injury associated with high free right internal mammary artery harvesting // Ann Thorac Surg. 2003. №76. P. 459-63. 13. Di Giorgio A., Cardini C.L., Sammartino P., Sibio S., Naticchioni E. Dual-layer sandwich meshrepair in the treatment of major diaphragmatic eventration in adult // J Thorac Cardiovasc Surg. 2006. №132. P. 187-189. 14. Donzeau-Gouge G.P., Personne C., Lechien J., Colchen A., Leroy M. et al. Eventration of the diaphragm in the adult - 20 cases // Sem Hop. 1982. №58. P. 2065-8. 15. Favre J.P., Favoulet P. et al. Tratamiento quiriírgico de las eventraciones diafragmaticas. ECM. Técnicas quinírgicas. Paris: Elsevier Masson SAS. 2005. 40-245. 16. Groth S.S., Andrade R.S. Diaphragmatic eventration // Thorac Surg Clin. 2009. №19. -P. 511-9. 17. Guy T.S., Montany P.F. Thoracoscopic diaphragmatic plication // Surg Laparosc Endosc. 1998. №8. P. 319-21. 18. Kuniyoshi Y., Yamashiro S., Miyagi K., Uezu T., Arakaki K., Koja K. Diaphragmatic plication in adult patients with diaphragm paralysis after cardiac surgery // Ann Thorac Cardiovasc Surg. 2004. №10. P. 1606. 19. Palanivelu C., Rangarajan M., Rajapandian S., Amar V., Parthasarathi R. Laparoscopic repair of adult diaphragmatic hernias and eventration with primary sutured closure and prosthetic reinforcement: a retrospective study // Surg. Endosc. 2009. №23. P. 978-85. 20. Petit J.L. Traite des maladies chirurgicales et des operations que leurs conviennent. Paris. 17-74p. References: 1. Aliev S.A., Rafiev S.F., Zeinalov B.M. Diagnostika i khirurgicheskoe lechenie razryvov diafragmy [Diagnostics and surgical treatment of diaphragm ruptures]. Khirurgiya [Surgery]. 2010. 10. pp. 22—28. [in Russian] 2. Borisov A.Y., Kubachev K.G., Kukushkin A.V., Zarkua N.E., Zajtsev D.A. Diafragmalnye gryshi, diagnostika I khirurgicheskoe lechenie[Diaphragmatic hernias. Difgnosis and surgical treatment]. Vestnik khirurgii I.I. Grekova [Grekov's Bulletin of Surgery]. 2012. 171:6. pp.38-42. [in Russian] 3. Dambaev G.Ts., Popov A.M., Gyunter V.E., Hodorenko V.N.Alloplastika diafragmy novymi biologicheski-adaptirovannymi nanomaterialami [Alloplasty of the diaphragm with the new biologically adapted nanomaterials]. Vestnik Roszdravnadzora [Bulletin of Roszdravnadzora]. 2011. 1.pp. 51-59. [in Russian] 4. Korymasov E.A., Chernyshev V.N., Pushkin S. Yu. Benyan A. S.Vybor operativnogo dostupa v khirurgii diafragmy [Choice of surgical approach in the surgery of the diaphragm]. Grudnaya i serdechno-sosudistaya khirurgiya [Thoracic and cardiovascular surgery]. 2010. 5. pp.69-71. [in Russian] 5. Parshin V.D., Parshin V.V., Mirzoyan O.S., Stepanyan A.A. Operazii na diafragme v planovoy torakal'noy khirurgii[Surgery of the diaphragm in the planned thoracic surgery]. Khirurgiya. Zhurnal im. N.I. Pirogova [Pirogov Russian Journal of Surgery]. 2013. 8. pp.7-13. [in Russian] 6. Parshin V.D., Khetagurov M.A. Khirurgiya relaksazii diafragmy [Diaphragm relaxation surgery]. Khirurgiya. Zhurnal im. N.I. Pirogova [Pirogov Russian Journal of Surgery]. 2018. 3. pp.4-14. [in Russian] 7. Petrovsky B.V., Moiseev V.S., Platov I.I. Khirurgiya nekotorykh zabolevaniy diafragmy [Surgery for certain diseases of the diaphragm]. Khirurgiya [Surgery]. 2000. 7. pp.23 - 27. [in Russian] 8. Topolnitskii Ye.B., Dambayev G.Ts., Shefer N.A., Khodorenko V.N., Fomina T.I., Gyunter V.Ye. Zameshcheniye postrezektsionnykh defektov perikarda, diafragmy, grudnoy stenki setchatym implantatom iz nikelida titana [Substitution of postresection defects of pericardium, diaphragm, thoracic wall by the implant of titanium nikelide fibers]. Voprosi rekonstruktivnoy i plasticeskoy hirurgii [The questions of reconstructive and plastic surgery]. 2012. 15. 1. pp. 14-21. [in Russian] 9. Khetagurov M.A. Rekonstruktivnyye operatsii na diafragme v planovoy torakal'noy khirurgii [Reconstructive operations on the diaphragm in elective thoracic surgery]. Dissertation for the degree of candidate of medical sciences. Moscow 2019 with. Moscow 2019. p. 111. [in Russian]
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Fokeev S.D., Kapitulin S.Yu., Kazantseva Ye.S., Kapitulina E.K., Syzdykbayev M.K., Khalelov S.G., Shavrovsky A.A.A new method of surgical treatment of diaphragm relaxation // Nauka i Zdravookhranenie [Science & Healthcare]. 2022, (Vol.24) 2, pp. 211-216. doi 10.34689/SH.2022.24.2.026