创伤性膈疝15例诊治体会

The experience of the diagnosis and treatment for traumatic diaphragmatocele

目的探讨创伤性膈疝的早期确诊手段,提高早期确诊率及治愈率。方法回顾分析由笔者经治的15例创伤性膈疝病例发病机制、临床表现、诊治经过及预后。结果由于对该病的认识不足,其中1例左侧膈疝延迟3年后治愈,7例伤后5d～9d确诊。无死亡病例。结论①形成膈疝的原因主要有暴力致腹压骤升及直接锐器伤等;②早期胸腹部损伤,膈疝症状易被掩盖;③胸片、B超是主要诊断手段;④手术是治疗创伤性膈疝的惟一方法;⑥提高临床医师对本病的认识,对可疑病人完善检查、严密观察、早期手术,是提高治愈率的关键。

Objective To study the means for early diagnosis of traumatic diaphragmatoceIe and to increase the early diagnosis rate and cure rate. Methods Reviewed the mechanism, clinic manifestation, diagnosis and treatment process and prognosis of 15 cases of traumatic diaphragmatocele. Results Owing to lack of experience for this disease, one case with left traumatic diaphragmatocele cured after 3 years, seven cases diagnosed in 5-9 days after injuried, and no death case. Conclusion （1）The main reason of traumatic diaphragmatocele is the sudden rise of celiac pressure because of violence and direct injury from sharp implements. （2）In the early stage of thorax-abdomen trauma , the symptom of traumatic diaphragrnatocele is easy to be covered.（3）X-ray sternum and ultrasound are the main diagnosis maens. （4）Operation is the only method to treat traumatic diaphragmatocele .（5）The key of increasing the cure rate is to strengthen the surgeons＇ experience of this disease, and complete the examinations, discover carefully and operate earlier.