闭合创伤性膈疝23例分析

Analysis of 23 Cases of Closed Traumatic Diaphragmatic Hernia

目的:探讨闭合创伤性膈疝的诊断及治疗特点。方法:回顾总结自1983年3月-2003年8月,经手术证实的23例 闭合创伤性膈疝病例。1例膈疝在右侧,其它22例全部发生在左侧。其中车祸伤11例,钝器伤7例坠落伤2例,塌方挤压伤 1例,食管癌手术膈肌缝合不全1例和"自发性"膈疝1例。结果:术前确诊创伤性膈疝的15例(65.2％),6例(26％)在急诊手术 中发现;2例误诊(8.7％);死亡1例(4.3%)。结论:(1)闭合性膈疝往往有合并伤,提高早期诊断准确性,是救治病人的关键(2)选择 正确手术方式能提高抢救成功率,降低死亡率。(3)右侧闭合创伤性膈疝尽管发生率低,也不应忽视时其特点的把握,以免漏诊。

Objective: To study the points of diagnosis and treatment of closed traumatic diaphragmatic hernia. Methods: To retrospectively summarize the 23 cases of closed traumatic diaphragmatic hernia surgically treated for the period of March 1983 to August 2003. All but 1 patient were the right herniation of closed injured , the others were found in the left plural cavity. In 11 of 23 cases was Motor vehicle accident, 7 cases suffered blunt injury. 2 cases had falling history,1 cases crushed injuries, 1 cases presented false suture of diaphragma in the course of esophageal carcinoma mastectomy ,and 1 cases presented spontaneous diaphragmatic among them. Results: For 23 cases, the diagnosis was made preoperatively in 15 cases(65.2%), 6(26%) were found diaphragmatic hernia in the emergency operation, 2(8.7%) missed diagnosis, and 1(4.3%) died. Conclusion: The frequent presence of other serious injuries associated to closed traumatic diaphragmatic hernia. Early recognition of diaphragmatic injury is required to avoid the potentially lethal complication. To choose proper operative approach are crucial for lower mortality. It should be important to keep a high index of suspicion to the right-side diaphragmatic hernia , even though it rarely occur.