Diaphragmatic folding for the management of phrenic nerve injury resulting from mediastinal tumor resection

doi:10.3877/cma.j.issn.1674-6899.2025.04.004

Abstract

Abstract:

Objective

To observe the application scope and experience of thoracoscopic diaphragmatic fold surgery in the treatment or prevention of complications of diaphragmatic nerve injury (tumor invasion or intraoperative injury).

Method

After phrenic nerve injury, the therapeutic effects were compared between patients with and without diaphragmatic plication. Therapeutic versus prophylactic diaphragmatic plication of the treatment course was compared. The symptoms and imaging were observed.

Results

In the period from Jan. 2022 to Jul. 2024, a total of 445 mediastinal tumor surgeries were performed, of which 49 involved the folding of the diaphragm. Among these, 5 patients underwent total thymectomy and diaphragm folding via minimally invasive surgery. Comparing the symptoms and imaging observations before and after surgery in patients with diaphragmatic nerve injury treated by thoracoscopic diaphragm folding, it was found that patients with improved symptoms of chest tightness; in patients with preventive diaphragm folding, no respiratory difficulty due to diaphragmatic bulging occurred after surgery, recovery was fast, and postoperative effects were good.

Conclusion

In mediastinal tumor resection without lung resection, thoracoscopic diaphragmatic folding surgery can treat or prevent complications of phrenic nerve injury in patients with phrenic nerve invasion or intraoperative injury, achieving satisfactory treatment results.

Key words: Phragmatic nerve injury, Thoracoscopy, Diaphragm folding

Yugang Fan, Jichen Qu, Jiang Fan. Diaphragmatic folding for the management of phrenic nerve injury resulting from mediastinal tumor resection[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(04): 211-214.

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URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2025.04.004

https://zhqjwkzz.cma-cmc.com.cn/EN/Y2025/V18/I04/211

Figures/Tables 5

References 9

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病例序号	性别	年龄	FVC	FEV1	左室射血分数	病理诊断	手术	二次手术
1	女	48岁	3.21 L	2.43 L	67%	胸腺囊肿	0	无
2	女	50岁	3.29 L	2.38L	65%	胸腺囊肿	2	有
3	男	51岁	2.93 L	2.97 L	66%	胸腺瘤B3型	1	无
4	男	66岁	2.90 L	2.65 L	62%	胸腺瘤B2型	1	无
5	女	38岁	3.48 L	2.47 L	69%	胸腺瘤AB型	1	无
6	男	57岁	3.01 L	2.87 L	64%	畸胎瘤	1	无

病例序号	性别	年龄	FVC	FEV1	左室射血分数	病理诊断	手术	二次手术
1	女	48岁	3.21 L	2.43 L	67%	胸腺囊肿	0	无
2	女	50岁	3.29 L	2.38L	65%	胸腺囊肿	2	有
3	男	51岁	2.93 L	2.97 L	66%	胸腺瘤B3型	1	无
4	男	66岁	2.90 L	2.65 L	62%	胸腺瘤B2型	1	无
5	女	38岁	3.48 L	2.47 L	69%	胸腺瘤AB型	1	无
6	男	57岁	3.01 L	2.87 L	64%	畸胎瘤	1	无

分组	术前	术后	气急缓解时间
未行膈肌折叠组(1例)	胸片、肺功能、血氧饱和度、心脏功能均正常。	胸片示膈肌膨升，肺部正常。气急主诉明显，平静时血氧饱和度约90%，平路活动后血氧饱和度85%~90%。	术后3~6个月气急症状逐渐缓解，气急期活动受限，前3个月经常吸氧。
出现症状后治疗性膈肌折叠组(1例)	胸片、肺功能、血氧饱和度、心脏功能均正常。	膈肌折叠治疗前胸片示膈肌膨升。膈肌折叠治疗后无膈肌膨升，肺部正常。膈肌折叠治疗前气急主诉明显，平静时血氧饱和度约90%，平路活动后血氧饱和度85%以下。膈肌折叠治疗后无明显气急主诉。二次手术后4 d出院。	二次手术后气急缓解，正常生活，平路活动无需氧气。
未出现症状预防性膈肌折叠组(4例)	胸片、肺功能、血氧饱和度、心脏功能均正常。	胸片示肺部正常，无膈肌膨升。无气急主诉，平静时血氧饱和度95%以上，平路活动后无明显降低。	术后无气急发生，正常生活，平路活动无需氧气。

分组	术前	术后	气急缓解时间
未行膈肌折叠组(1例)	胸片、肺功能、血氧饱和度、心脏功能均正常。	胸片示膈肌膨升，肺部正常。气急主诉明显，平静时血氧饱和度约90%，平路活动后血氧饱和度85%~90%。	术后3~6个月气急症状逐渐缓解，气急期活动受限，前3个月经常吸氧。
出现症状后治疗性膈肌折叠组(1例)	胸片、肺功能、血氧饱和度、心脏功能均正常。	膈肌折叠治疗前胸片示膈肌膨升。膈肌折叠治疗后无膈肌膨升，肺部正常。膈肌折叠治疗前气急主诉明显，平静时血氧饱和度约90%，平路活动后血氧饱和度85%以下。膈肌折叠治疗后无明显气急主诉。二次手术后4 d出院。	二次手术后气急缓解，正常生活，平路活动无需氧气。
未出现症状预防性膈肌折叠组(4例)	胸片、肺功能、血氧饱和度、心脏功能均正常。	胸片示肺部正常，无膈肌膨升。无气急主诉，平静时血氧饱和度95%以上，平路活动后无明显降低。	术后无气急发生，正常生活，平路活动无需氧气。

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