Therapeutic effects of diaphragmatic plication for acquired unilateral non-malignant diaphragm paralysis in twenty patients

Bagheri , Reza; Haghi , Seyed Ziaollah; Rajabi Mashhadi , Mohammadtaghi; Tavassoli , Alireza; Attaran , Davoud; Akhlaghi , Saeed; Barekati , Neusha; Esmaeeli , Maryam

Volume 71, Issue 9 (December 2013) Tehran Univ Med J 2013, 71(9): 577-583 | Back to browse issues page

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Bagheri R, Haghi S Z, Rajabi Mashhadi M, Tavassoli A, Attaran D, Akhlaghi S, et al . Therapeutic effects of diaphragmatic plication for acquired unilateral non-malignant diaphragm paralysis in twenty patients. Tehran Univ Med J 2013; 71 (9) :577-583
URL: http://tumj.tums.ac.ir/article-1-5683-en.html

Therapeutic effects of diaphragmatic plication for acquired unilateral non-malignant diaphragm paralysis in twenty patients

Reza Bagheri¹

, Seyed Ziaollah Haghi¹

, Mohammadtaghi Rajabi Mashhadi ^*

², Alireza Tavassoli³

, Davoud Attaran⁴

, Saeed Akhlaghi⁵

, Neusha Barekati⁶

, Maryam Esmaeeli⁷

1- Department of Thoracic Surgery, Cardio- Thoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2- Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. , rajabimt@mums.ac.ir
3- Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
4- Tuberculosis Research Center, Mashhad University of Medical Science, Mashhad, Iran.
5- Department of Statistics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
6- General Practitioner, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
7- Student of Medical Sciences.

Abstract: (27216 Views)

Background: Acquired paralysis of the diaphragm is a condition caused by trauma, surgical injuries, (lung cancer surgery, esophageal surgery, cardiac surgery, thoracic surgery), and is sometimes of an unknown etiology. It can lead to dyspnea and can affect ventilatory function and patients activity. Diaphragmatic plication is a treatment method which decreases inconsistent function of diaphragm. The aim of this study is to evaluate the outcome of diaphragmatic plication in patients with acquired unilateral non-malignant diaphragmatic paralysis. Methods: From 1991 to 2011, 20 patients with acquired unilateral diaphragmatic paralysis who underwent surgery enrolled in our study in Ghaem Hospital Mashhad University of Medical Science. Patients were evaluated in terms of age, sex, BMI, clinical symptoms, dyspnea score (DS), etiology of paralysis, diagnostic methods, respiratory function tests and complication of surgery. Some tests including dyspnea score were carried out again six months after surgery. We evaluated patients with SPSS version 11.5 and Paired t-test or nonparametric equivalent. Results: Twenty patients enrolled in our study. 14 were male and 6 were female. The mean age was 58 years and the average time interval between diagnosis to surgical treatment was 38.3 months. Acquired diaphragmatic paralysis was mostly caused by trauma (in 11 patients) and almost occurred on the left side (in 15 patients). Diagnostic methods included chest x-ray, CT scan, ultrasonography and sniff. Test prior to surgery the average FVC was 41.4±7 percent and the average FEV1 was 52.4±6 percent and after surgery they were 80.1±8.6 percent and 74.4±1 percent respectively. The average increase in FEV1 and FVC 63.4±4, 61.1±7.8. Performing surgery also leads to a noticeable improvement in dyspnea score in our study. Conclusion: In patients with acquired unilateral non-malignant diaphragm paralysis diaphragmatic plication is highly recommended due to the remarkable improvement in respiratory function tests and dyspnea score without mortality and acceptable morbidity.

Keywords: diaphragmatic eventration, dyspnea score, treatment outcome

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