莫尔加尼疝（隔疝）常见问题【英文讲义】

莫尔加尼疝是什么？

先天性膈疝（CDH）是一种先天性畸形的隔膜。CDH最常见的形式是真正的Bochdalek疝;其他样式包括莫尔加尼疝，膈肌膨出和在膈中心腱缺陷的。
畸形的隔膜，使腹部器官，以推动在适当的肺部形成。先天性膈疝是一种威胁生命的病理中的婴儿，加上的两个并发症：肺发育不良和肺动脉高压的主要死亡原因。关于这两个条件的相对重要性，专家们的看法不一，通过把重点放在发育不全，别人对高血压。新生儿先天性膈疝，往往有严重的呼吸窘迫，可危及生命，除非适当的治疗。
莫尔加尼疝介绍如何在成人吗？
在成人莫尔加尼疝，一般无症状，在其他条件腹腔镜检查或影像学检查时偶然发现的。但是，他们可能会表现为腹痛，绞窄疝内容物的紧急情况。在许多成年报告莫尔加尼疝绞窄莫尔加尼疝，出现呕吐和腹痛由于在极端的情况下，一个胃扭转。
Bochdalek疝是什么？
Bochdalek疝，也简称为后外侧膈疝，被视为CDH共同指示，使得95％以上的cases.In此实例的特定的膜片的特征在于异常的开口在postero允许通过的隔膜，在胸腔与腹腔脏器的侧角。许多Bochdalek疝气（80-85％）的隔膜发生在左侧，从剩余的情况下，绝大多数发生周围的右侧，以及一小部分是双边的，这是左侧和右侧的缺陷。一个很好的的助记符是“Bochdalek的左侧是”。
莫尔加尼疝是什么？
莫尔加尼疝是罕见的前缺陷的隔膜可变莫尔加尼，胸骨，胸骨旁疝。莫尔加尼疝弥补多数CDH案件约2％时，可以被看作是从椎间孔莫尔加尼至剑突的sternum.Virtually所有疝气发生的身体上的右侧的技术，其可位于紧靠一个症和一般无症状，但新生儿可能会出现呼吸窘迫，出生时就像Bochdalek疝。另外，复发性胸部感染和胃肠道症状已经报道的人有先前确诊莫尔加尼疝。在无症状患者，腹腔镜手术修复也容易出现绞窄肠，仍建议。
是什么膜片膨出？
先天性膈肌膨出的诊断时，可以使用有异常部分或大部分的胸腔中的一个正常完整的隔膜的位移或仰角。这种罕见的类型，CDH所谓的隔膜膨出，是因为有关膨出隔膜较薄，使腹腔脏器向上伸出。这种细化的隔膜被认为是采取的从隔膜muscularisation不完整的地方，因为，可以发现单侧或双侧。次要类型的膈肌膨出是无症状的，在严重的情况下的婴儿将显示呼吸窘迫很像Bochdalek疝。
先天性横膈膜疝气如何诊断？
前诊断先天性膈疝的问题往往可以偶尔可以帮助分娩和胎儿的干预，严酷的情况。膈疝经验呼吸衰竭，因为肺动脉高压和肺发育不全的婴儿出生。先天性膈疝的首要条件是一个真正的限制，通过肺部被认为所带来的缺陷，在肺的血流量。肺发育不全或上腹部器官在胸腔，这反过来又导致肺部严重不足的先天性膈疝的情况下，特别是协助疝的肺容积减少有关。这个特定条件的先天性膈疝的婴儿的存活率有所不同，但一般都不断增加，新生儿医学的进步。工作就可以完成相关的存活率，肺容积比超声测量宝宝的头围。这个数字称为肺去比（LHR）。一小部分的情况下，无法辨识。

Margogni疝腹腔镜修补的是如何进行的？
腹腔镜的莫尔加尼疝气修复是一个相对简单和有效的最低限度的访问的手术方法修复的儿童与突显性的优势。莫尔加尼疝气通常是简单的修复比较其他类型的前内侧膈肌缺损。相对于后外侧隔膜缺陷，这是非常困难的，以暴露腹腔镜，前的缺陷可以很容易地看到这种方法的微创手术。
腹腔镜手术是通过打开或Veress针头插入有10毫米的端口在肚脐和随后的两个的5毫米端口插入。应被困在疝，胃，横结肠及大网膜。减少后的囊切开颈部和膈肌缺损边缘的困难。在极端情况下，有可能是大断面网膜坏死，应切除并放置到检索袋和随后被移除。横结肠和胃或肠袢，应仔细检查，并看作是可行与否。镰状韧带，可以发现一段时间囊壁的一部分，这是减少囊切除​​。的边缘应广泛清除腹膜和脂肪的隔膜肌肉和筋膜暴露的缺陷。缺陷的某个时候可能会发现大，而有时可能不适合初级关闭。Polypropelene网应该被使用。约2〜3厘米以上的缺陷，膜片的边缘重叠网应足够大，以获得良好的缓缴膈肌，并应保证在使用5毫米钛金属大头钉，Protack的。有时inturrupted体外平结，可用于腔内翻转平结固定的网格。

原文：

Frequently Asked Questions on the Morgagni Hernia



What is Morgagni Hernia?

Congenital diaphragmatic hernia (CDH) is a congenital malformation in the diaphragm. The most frequent form of CDH is really a Bochdalek hernia; other styles include Morgagni hernia, diaphragm eventration and central tendon defects in the diaphragm.

Malformation from the diaphragm allows the abdominal organs to push in the proper lung formation. Congenital diaphragmatic hernia is a life-threatening pathology in infants, plus a major reason behind death on account of two complications: pulmonary hypoplasia and pulmonary hypertension. Experts disagree about the relative significance about these two conditions, by incorporating focusing on hypoplasia, others on hypertension. Newborns with Congenital diaphragmatic hernia often have severe respiratory distress which can be life-threatening unless treated appropriately.

How the Morgagni Hernia Presents in Adult?

In adults Morgagni Hernia is generally asymptomatic and are found incidentally during laparoscopy or imaging for another condition is done. However, they may present as an emergency with abdominal pain due to strangulation of the hernia contents. In many adult morgagni hernia is reported as a strangulated Morgagni hernia, which presented with vomiting and abdominal pain due to a gastric volvulus in extreme cases.

What is Bochdalek hernia?

The Bochdalek hernia, also referred to as a postero-lateral diaphragmatic hernia, is regarded as the common indication of CDH, making up a lot more than 95% of cases.In this instance the diaphragm abnormality is characterized by an opening in the postero-lateral corner of the diaphragm which allows passage with the abdominal viscera in the chest cavity. Many Bochdalek hernias (80-85%) occur on the left side in the diaphragm, the great majority from the remaining cases occur around the right side, as well as a tiny proportion are bilateral, which is left- and right-sided defects. A good mnemonic is "Bochdalek is back also to the left".

What is Morgagni Hernia?

Morgagni Hernia is rare anterior defect of the diaphragm is variably called Morgagni, retrosternal, or parasternal hernia. Making up approximately 2% of most CDH cases, Morgagni Hernia can be seen as an herniation from the foramina of Morgagni which can be located immediately adjacent to the xiphoid technique of the sternum.Virtually all hernias occur on the right side of the body and are generally asymptomatic; However newborns may present with respiratory distress at birth just like Bochdalek hernia. Additionally, recurrent chest infections and gastrointestinal symptoms have already been reported in people that have previously undiagnosed Morgagni hernia. In asymptomatic individuals laparoscopic surgical repair is still recommended as is also prone to a strangulated intestine.

What is Diaphragm Eventration?

The diagnosis of congenital diaphragmatic eventration can be used when there is abnormal displacement or elevation of part or most of a normally intact diaphragm in the chest cavity. This rare type of CDH called Diaphragm eventration, occurs because about eventration the diaphragm is thinner, allowing the abdominal viscera to protrude upwards. This thinning of diaphragm is thought to take place because of incomplete muscularisation from the diaphragm, and could be found unilaterally or bilaterally. Minor types of diaphragm eventration are asymptomatic, in severe cases infants will show with respiratory distress much like Bochdalek hernia.

How the Congenital Diaphragmatic Hernia is diagnosed?

Congenital diaphragmatic hernia issue can often be diagnosed before birth and fetal intervention can occasionally help, with respect to the harshness of the situation. Infants born with diaphragmatic hernia experience respiratory failure because of both pulmonary hypertension and pulmonary hypoplasia. The very first condition of Congenital diaphragmatic hernia is really a restriction of the flow of blood through the lungs thought to be brought on by defects in the lung. Pulmonary hypoplasia or decreased lung volume is related on the abdominal organs presence within the chest cavity which in turn causes the lungs being severely undersized in case of Congenital diaphragmatic hernia, especially assisting the hernia. Survival rates for infants with this particular condition of Congenital diaphragmatic hernia vary, but have generally been increasing through advances in neonatal medicine. Work may be completed to correlate survival rates to ultrasound measurements of the lung volume than the baby's head circumference. This figure referred to as lung to go ratio (LHR). A small percentage of cases go unrecognized up.



How the Laparoscopic Repair of Margogni Hernia is performed?

Laparoscopic repair of Morgagni hernias is a relatively simple and effective minimal access surgical method of repair in children with accentuated advantages. Morgagni hernias are anteromedial diaphragmatic defects that are typically simple to repair compare to other types. As opposed to posterolateral defects of diaphragm, which are very difficult to expose laparoscopically, the anterior defects can be easily seen with this approach of minimal access surgery.

Laparoscopic surgery is done via open or veress needle insertion of a 10 mm port at the umbilicus and subsequent insertion of two 5 mm ports. The stomach, transverse colon and omentum should be trapped in the hernia. They were reduced with difficulty after incising the neck of the sac and the edge of the diaphragmatic defect. In extreme There may be large section of necrotic omentum, which should resected and placed into a retrieval bag and subsequently removed. The transverse colon and stomach or bowel loops should be carefully examined and seen to be viable or not. The falciform ligament can be found sometime as part of the wall of the sac and this was reduced along with the sac and excised. The edges of the defect should be widely cleared of peritoneum and fat to expose the muscle and fascia of the diaphragm. The defect sometime may be found large and sometime may not suitable for primary closure. Polypropelene mesh should be used. The mesh should be big enough with approximately 2 to 3 cm of overlap over the edges of the defect of diaphragm to get a good hold over the diaphragmatic muscle and should be secured in place using 5 mm titanium tacks, called Protack. Sometime inturrupted extracorporeal square knot and intracorporeal tumble square knot can be used to fix the mesh.