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題 名 | Eventration of the Diaphragm in Adults--Experience at Taipei-VGH=成年人之橫膈上提--臺北榮總之經驗 |
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作 者 | 林志銘; 吳玉琮; 許文虎; 黃敏雄; 王良順; | 書刊名 | 胸腔醫學 |
卷 期 | 17:4 2002.12[民91.12] |
頁 次 | 頁340-345 |
分類號 | 416.22 |
關鍵詞 | 橫膈上提; 橫膈摺疊術; Diaphragmatic eventration; Plication; |
語 文 | 英文(English) |
中文摘要 | 橫膈上提(diaphragmatic eventration)為一種少見且原因不明之疾病,病患之橫膈膜有部份或全部上提之情形,但其與肋骨之接合處為完整的。就新生兒患者而言,若有呼吸障礙之情形,往往需要立刻即施予氣管內插管及手術矯正;就成人而言,手術治療僅建議於有呼吸或腸道症狀之患者來施行。從1978年至2001年,本科共有11科橫膈上提之患者接受治療,其年齡分佈從34至82歲,平均年齡為55.3歲。男性患者6位,女性患者5位;左側橫膈上提者9位,右側2位;完全型橫膈上提者9位,部份上提者2位。共有10位患者因具症狀而接受手術治療(包括9位手術前診斷為橫膈上提及一位疑為橫膈腫瘤),另一位無症狀患者,僅接受胸腔鐘檢查而確定診斷,並未接受進一步治療。因此,術前之誤診率可高達18.2%。前述接受手術治療之10位病患,並無併發症或死亡之發生,術後無論是客觀或主觀評估,症狀均獲得改善。依據吾等之經驗,橫膈摺疊術對有症狀之橫膈上提患者而言,為一種既安全又有效之治療方式。 |
英文摘要 | Diaphragmatic eventration is a condition with all or a portion of the hemidiaphragm elevated permanently, yet retaining its continuity and normal attachments to the costal margins. This diaphragmatic disease is rare and the cause is yet to be understood. In newborns, eventration with respiratory failure may require intubation and immediate surgical attention. For adults, indications for surgery are uncommon, and one must be very careful before recommending placation for respiratory or digestive symptoms. From 1978 to 2001, eleven adults were treated for diaphragmatic eventration, and their data were reviewed for this study. Their ages at diagnosis ranged form 34 to 82 years, with a mean of 55.3 years. Male and female were almost equally affected (6 men, 5 women). The left diaphragm was more frequently involved (9 left, 2 right). Ten symptomatic patients underwent exploratory thoracotomy, and one asymptomatic patient underwent thoracoscopy to confirm the diagnosis. Nine cases were classified as complete types, and the other two as partial types. Two of the 11 patients obtained a definitive diagnosis only after surgical intervention under the impression of diaphragmatic neoplasms. Diaphragmatic placations were performed for all ten symptomatic patients. The asymptomatic patient didn't undergo management after the diagnosis was confirmed via thoracoscopy. No surgical complication or mortality was encountered in our series. All ten symptomatic patients showed both subjective and objective improvement after operation. Based on our experience, diaphragmatic placation is a safe and effective procedure in the management of patients with symptomatic eventration. |
本系統中英文摘要資訊取自各篇刊載內容。