Lung hernia

　　Firstly, etiology

　　The etiology and pathogenesis of lung hernia are not the same for lung hernia at different sites and different pathological types. According to comprehensive literature reports, the etiology and pathogenesis are closely related to local defects or weaknesses caused by congenital developmental abnormalities or acquired injuries.

　　1. Local developmental abnormality or weakness

　　(1) There is a fissure between the sternocleidomastoid muscle and the anterior oblique muscle of the neck, and the tension at the apex of the lung is relatively high, with a large difference in expansion and contraction, which can cause local muscle relaxation. Especially when Sibsons fascia is defective, weak, or torn, lung tissue can herniate into the neck through this weak fissure, causing cervical lung hernia.

　　(2) There are physiological weak points in the anterior upper part and the posterior lower part of the mediastinal pleura. When the weakness is obvious or there are other developmental defects (such as the absence of one lung on one side), lung tissue is prone to protrude through this area into the mediastinum to form mediastinal lung hernia. Because the mediastinum and the neck are connected, the disease can extend to the neck during the development, forming a mediastinum-neck type lung hernia.

　　2. Trauma:Trauma can cause defects and weakness of the chest wall. When the intrathoracic or pulmonary pressure is abnormally increased, lung tissue can herniate into the intercostal space, causing chest (intercostal) lung hernia.

　　(1) Rib fracture, tear of pleural parietal layer and chest wall muscle, can cause defects, weakness, or pneumothorax of the chest wall, and then cause lung hernia.

　　(2) Local nerve injury caused by trauma, etc., over time causing local muscle atrophy, decreased tension, and forming lung hernia.

　　(3) Improper treatment of pleural parietal layer and intercostal tissue injury, such as chest wall penetrating injury with a long wound, only sutured the skin of the chest wall, but not the muscle and pleural parietal layer of the chest wall, can lead to the occurrence of lung hernia. There are even reports of lung hernia occurring due to repeated multiple thoracentesis.

　　3. Increased intrathoracic or pulmonary pressure:For example, pneumothorax can promote the herniation of lung tissue from the defective and weak parts.

　　4. Genetics:Chen Runde and others (1994) reported that four people in a family of three generations had cervical lung hernia, all without a history of trauma, chronic respiratory system diseases, or any precipitating factors. They proposed that the disease may be an autosomal dominant genetic disease based on the continuous transmission phenomenon of lung hernia in the family. However, no abnormalities were found in the family chromosome examination, and no similar reports were found either. Therefore, whether lung hernia is a dominant genetic disease still needs to be further confirmed.

　　Secondly, pathogenesis

　　1. Pathology:The sac of lung hernia is the pleural parietal layer. The hernial orifice of cervical lung hernia is the fissure between the sternocleidomastoid muscle and the anterior oblique muscle, the hernial orifice of mediastinal lung hernia is the physiological weak area in the anterior upper part and the posterior lower part of the mediastinal pleura, and the hernial orifice of pleural (intercostal) lung hernia is the damaged and defective part of the chest wall. The contents of the hernia are lung tissue, and most of them belong to the 'sliding type', and incarceration occurs rarely. When the lung hernia is small, it has no obvious effect on physiological functions such as respiration; if the hernia mass is large, it can cause incarceration or compression symptoms, such as a large cervical lung hernia compressing the carotid artery and causing corresponding symptoms.

　　2. Classification:Pathological typing is performed according to the cause of onset and the location of herniation of the lung hernia.

　　(1) Classification by etiology: There are congenital pleural hernia and acquired pleural hernia. The latter includes traumatic pleural hernia, spontaneous pleural hernia, and pathologic pleural hernia. Pathologic pleural hernia is mostly caused by tumors or infections.

　　(2) Classification by occurrence site: There are cervical pleural hernia, chest wall (intercostal) pleural hernia, diaphragmatic pleural hernia, and mediastinal pleural hernia. Among them, cervical pleural hernia has the highest incidence, accounting for 50% to 60% of the disease.

　　I. Intestinal incarceration:Under normal circumstances, the contents of the hernia (usually the intestine) can be pushed into the hernia sac under the action of abdominal pressure and can be retracted into the abdominal cavity by itself (or by external force). When various reasons (such as friction, adhesion, etc.) cause the contents of the reducible hernia to suddenly be unable to be retracted, and the local mass increases, it indicates that intestinal incarceration has occurred, and this is called an incarcerated hernia. After intestinal incarceration, the main clinical manifestations are those of intestinal obstruction.

　　II. Intestinal strangulation:If the incarcerated hernia persists and is not treated and handled in time, the contents of the hernia (mainly the intestine) may experience circulatory disturbances, leading to intestinal obstruction, intestinal necrosis, and even intestinal perforation, resulting in serious consequences such as strangulated hernia. The clinical manifestations of intestinal strangulation include:

　　1. Sudden, persistent, and severe abdominal pain.

　　2. Tachycardia, tachypnea, and increased white blood cell count, showing signs of shock.

　　3. Peritoneal irritation signs (local tenderness, rebound pain, muscle tension, etc.).

　　4. Bowel sounds change from hyperactive to hypoactive or disappear, and 'water over sand' sounds can be heard.

　　5. Vomiting blood (or bloody fluid) or hematochezia.

　　6. The abdomen can be palpated for obvious swelling, bulging, and masses.

　　7. X-ray examination shows an isolated dilated intestinal tube or changes in the small intestinal location within the abdomen, with widened intestinal space, elevated, and abdominal fluid.

　　8. Puncture of the abdominal cavity can aspirate bloody fluid.

　　The symptoms and signs of pleural hernia are related to its location, size, and type.

　　1. When the pleural hernia of the neck is small, there is usually no significant discomfort, and only soft tissue masses can be seen in the neck during coughing and asthma. The mass appears and disappears intermittently, and the soft tissue mass is more obvious during straining. If a large amount of lung tissue herniates, local distension can occur, causing discomfort when turning the head, and a few cases may have difficulty breathing, even compressing the carotid artery to produce corresponding symptoms. Physical examination: Soft tissue masses can be palpated above the clavicle, and they are more obvious during straining and holding the breath. The mass can be heard to have respiratory sounds.

　　2. Patients with pleural (intercostal) hernia usually have a history of chest wall injury, and generally onset after several weeks or months of injury. The main symptoms and signs are the bulge of the chest wall at the site of injury. The characteristic of the chest wall mass formed by intercostal pleural hernia is that it increases during exhalation and decreases during inhalation. Most of them are asymptomatic and can also have local pain with local bulging sensation, coughing, and straining. The bulge is more obvious. It feels soft and elastic, and can disappear after kneading.

　　Prevention:There is currently no effective preventive measure for this disease. Pay attention to health, do a good job of safety protection, reduce and avoid the stimulation of adverse factors and accidental injuries, which can play a certain preventive role; in addition, early detection, early diagnosis, and early treatment are also the key to the prevention and treatment of the disease. In case of onset, active treatment and proactive intervention should be carried out to prevent the occurrence of complications.

　　Firstly, X-ray fluoroscopy film examination:

　　1. Cervical lung hernia X-ray fluoroscopy can see a gas-containing soft tissue shadow in the neck connected with the lung tissue at the apex of the lung. The size of the soft tissue shadow in the neck is significantly positively correlated with the pressure in the chest cavity. The soft tissue shadow increases during inhalation and decreases during exhalation, showing a regular periodic change in size.

　　2. Chest lung hernia tangential chest radiography can see a translucent bulge with enhanced transparency, connected with lung tissue.

　　Secondly, CT scan:It can clearly show the chest, pleural cavity, and herniated lung tissue, such as during the CT scan of cervical lung hernia, lung texture can be found on the cervical vertebral section.

　　Firstly, what foods should be eaten with lung hernia to benefit the body

　　Diet should be light. In the first few days after surgery, adjust the diet according to personal condition, mainly with fluid and semi-liquid foods, and eat more high-protein foods to promote wound healing. Supplement a variety of vitamins, eat more fresh vegetables and fruits. Various lean meats, milk, eggs, and other foods rich in protein can be eaten more.

　　Secondly, what foods should not be eaten with lung hernia

　　Avoid too greasy foods, foods that should not be chosen: Fermented bean curd, scallions, chili peppers, chives, and other foods are not conducive to wound healing because they are easy to cause infection.

　　(The above information is for reference only, for detailed information, please consult a doctor)

　　Treatment

　　If there are no obvious clinical symptoms in cervical lung hernias, no special treatment is needed; if the lung hernia is large, there is an incarcerated hernia, or there is compression of the carotid artery, surgical treatment can be performed.

　　Most traumatic intercostal hernias require surgical repair, with the key points being: ligating the sac at the neck of the hernia, resecting the redundant hernia sac (to prevent the formation of a cyst on the chest wall), and suturing and repairing the defect in the chest wall. There are several methods of suturing and repairing the defect in the chest wall: ① rib-to-rib method, that is, bringing the upper and lower ribs of the hernia orifice close together; ② Doberer method, that is, freeing the periosteum of the upper and lower ribs of the hernia orifice and then suturing them; ③ MarlexMesh can also be used for repair; ④ if the fracture of the rib is the cause, internal fixation of the rib should be performed.