外伤性膈疝23例诊治体会

Experience in diagnosis and treatment of traumatic diaphragmatic hernia:Report of 23 cases

目的探讨外伤性膈疝的诊断和治疗方法。方法回顾性分析我院1994年1月～2005年6月间收治的外伤性膈疝23例的临床资料。结果本组术前诊断明确者14例，误诊9例；治愈20例，死亡3例。结论临床经验不足是导致外伤性膈疝误诊、漏诊的主要原因。X线和CT检查在膈疝的诊断中有重要的作用；胸腔穿刺抽出胃肠道内容物对于膈疝的诊断有很大的意义，但应在X线监控下进行，以免发生副损伤。外伤性膈疝一经确诊，应立即手术治疗。

Objective To summarize the experience in diagnosis and treatment of traumatic diaphragmatic hernia. Methods The clinical data of 23 cases of traumatic diaphragmatic hernia from January 1994 to June 2005 were retrospectively analyzed. Results Of the 23 cases, 14 cases were preoperatively diagnosed,9 cases misdiagnosed. Twenty cases were cured and 3 cases died. Conclusion Lack of clinical experience is the main cause of traumatic diaphragmatic hernias misdiagnosis. X-ray and CT are important to improve the diagnosis rate of traumatic diaphragmatic hernia, and taking out the internal material of stomach by chest puncture is very significant to diagnosis, but it should be under the observations of X-ray. Once traumatic diaphragmatic hernia is diagnosed it should be treated by surgery immediately.