一种罕见的非食管型跨膈疝,必须与旁食管疝明确区分开来,是以先天性疝-Bochdalek疝和Larey-Morgagni疝的通用名称命名的膈缺损,分别。病因学基础相对简单:预先形成的解剖开口的存在,或不允许从胸部区域转移到腹部区域,或,大多数情况下,反之亦然,从腹部到胸部,各种内脏元素(脾脏,肝脏,胃,结肠,胰腺,等。).除了先天起源,描述了一个比较罕见的群体,约占总数的1-7%:创伤性类型的获得性变体,经常通过冲突型机制,产生膈肌应变/破裂。显然,症状是异质的,取决于疝气的位置,缺陷的尺寸,哪个腹部内脏通过疝开口参与,它的迁移程度,以及是否有容积/缺血/阻塞现象。通常,它的临床表现适中,主要是偶然的发现,大多数是消化表现。严重的消化系统并发症,如绞窄,Volvus,穿孔罕见,并伴有严重休克,在几个非特异性消化前驱体之后突然出现。诊断结合影像学评估(普通放射学,对比,CT)与内窥镜检查。无论膈肌缺损所在的一侧或潜在并发症的继发症状如何,都建议进行手术治疗。方法是胸部的,腹部或胸腹联合入路,经典或微创。大多数情况下,选择方法的类型应考虑两个因素:缺陷的大小,通过CT评估,以及主要并发症的存在。任何大于5cm2(食管裂孔疝表面(HSA))的食管裂孔缺损都有网状加固的正式建议。复发率不容忽视,统计数据表明,术后第一年是复发的主要时期,与缺陷的大小成正比。因此,在需要使用网状物的患者中,复发率介于27%和41%之间(!),而对于初级缝合的病例,即,有适度的膈肌缺陷,这是大约。4%。
A rare entity of non-hiatal type transdiaphragmatic hernias, which must be clearly differentiated from paraoesophageal hernias, are the phrenic defects that bear the generic name of congenital hernias-Bochdalek hernia and Larey-Morgagni hernia, respectively. The etiological substrate is relatively simple: the presence of preformed anatomical openings, which either do or do not enable transit from the thoracic region to the abdominal region or, most often, vice versa, from the abdomen to the thorax, of various visceral elements (spleen, liver, stomach, colon, pancreas, etc.). Apart from the congenital origin, a somewhat rarer group is described, representing about 1-7% of the total: an acquired variant of the traumatic type, frequently through a contusive type mechanism, which produces diaphragmatic strains/ruptures. Apparently, the symptomatology is heterogeneous, being dependent on the location of the hernia, the dimensions of the defect, which abdominal viscera is involved through the hernial opening, its degree of migration, and whether there are volvulation/ischemia/obstruction phenomena. Often, its clinical appearance is modest, mainly incidental discoveries, the majority being digestive manifestations. Severe digestive complications such as strangulation, volvus, and perforation are rare and are accompanied by severe shock, suddenly appearing after several non-specific digestive prodromes. Diagnosis combines imaging evaluations (plain radiology, contrast, CT) with endoscopic ones. Surgical treatment is recommended regardless of the side on which the diaphragmatic defect is located or the secondary symptoms due to potential complications. The approach options are thoracic, abdominal or combined thoracoabdominal approach, and classic or minimally invasive. Most often, selection of the type of approach should be made taking into account two elements: the size of the defect, assessed by CT, and the presence of major complications. Any hiatal defect that is larger than 5 cm2 (the hiatal hernia surface (HSA)) has a formal recommendation of mesh reinforcement. The recurrence rate is not negligible, and statistical data show that the period of the first postoperative year is prime for recurrence, being directly proportional to the size of the defect. As a result, in patients who were required to use mesh, the recurrence rate is somewhere between 27 and 41% (!), while for cases with primary suture, i.e., with a modest diaphragmatic defect, this is approx. 4%.