Long-term Results Of Diaphragmatic Plication In Adults Diaphragm Eventration

Objective: Diaphragmatic eventration is defined as a permanent elevation of a hemidiaphragm without defects of continuity. Diaphragmatic plication is a standard, classical technique to treat diaphragmatic eventration. The purpose of operation is to strengthen the diaphragm, reduce the diaphragm contradiction, improve the clinical symptoms and the quality of life of patients. There still were many disagreements about the long-term effect of operation, especially about the improvement of pulmonary function. But report published is most of with small series and short follow-ups. This follow-up retrospective study, which was conducted in this context, was aimed to evaluate the long-term efficacy and clinical value of diaphragmatic plication for adult diaphragmatic eventration.Method: We selected the files of 15 postoperative patients who had undergone diaphragm plication between January 2008 and October 2011 in Tianjin Chest Hospital to follow-up standardly. Collect the data of clinical symptoms, chest X-ray and pulmonary function tests respectively, combined with clinical analysis,to comparatively evaluate the long term effect of Diaphragmatic plication in the treatment of adult diaphragmatic eventration. Especially assess the alterment of pulmonary function and the improvement of the quality of life of patients after operation before and after operation.Result: Comprehensive comparison of the data in this follow-up retrospective study, combined with clinical analysis we can draw the following result. All patients' dyspnea symptoms had improvement or elimination. Among them, 2 cases with gastrointestinal symptoms and 1 case with chest pain were cure, and 1 case with palpitations was reduced significantly. The postoperative hospital stay of patients is 7-16 days. The mean of postoperative hospital stays was10.53±3.54 days. There is 1 case of patients with mediastinal emphysema after operation. There was not anyone patient death. Results follow-up showed no surgical complications occur in any patient such as abdominal visceral injury, pulmonary infection. All patients' chest X-ray showed that the position of the diaphragm was restored to normal. In 3 years after operation all patients' chest X-ray showed that the position of the diaphragm was restored to normal. Mean preoperative FVC was 2.35±0.16 and FEV1 1.78±0.46. FVC and FEV1 improved by 2.96±0.16(p<0.01) and 2.19±0.53(p<0.01) respectively in 3 years after operation.Conclusions: 1. Diaphragmatic plication for diaphragm eventration is a effective treatment. Operation cannot only improve the clinical symptoms of the patients, but also has a significant effect on the improvement of the long-term symptoms and the quality of life. 2. It is not temporary, but sustained, that diaphragmatic plication corrected the anatomic location of the diaphragm through the comparison of preoperative and postoperative 3 years with chest X-ray shows. 3. Diaphragmatic plication can effectively improve the patient's pulmonary function; it's a efficacy treatment of diaphragm eventration. Our study showed that the pulmonary function of long-term postoperative patients improved significantly. As a conclusion, diaphragm patients showed both objective and subjective improvement in long-term period after plication. Hence, it ensures remission of symptoms, and improves quality of life in long-term period.