A NEW METHOD OF SURGICAL TREATMENT OF DIAPHRAGM RELAXATION

Abstract

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.