21例创伤性膈肌破裂临床分析

DIAGNOSIS AND TREATMENT OF TRAUMATIC DIAPHRAGMATIC RUPTURE (21 CASES REPORT)

目的:探讨创伤性膈肌破裂的诊治体会。方法:回顾性分析我科2003年3月至2006年8月收治的21例创伤性膈肌破裂的临床资料。结果:所有病例均行剖胸探查、膈肌修补术,其中左侧膈肌破裂13例(61.9%),右侧膈肌破裂7例(33.3%),双侧膈肌破裂1例(4.76%)。术后肺不张3例行纤支镜检查治疗,2例无效再行气管切开。治愈20例(95.24%),随访胸片正常,无肺功能受损;死亡1例(4.76%)。结论:创伤性膈肌破裂应早期明确诊断,急诊开胸探查,修补破裂膈肌。对意识不清、咳痰乏力患者应早期行气管切开,保障呼吸道畅通,预防肺部感染。

Objective： To discuss the diagnosis and treatment of traumatic diaphragmatic rupture. Methods： The clinical data of 21 cases diagnosed as traumatic diaphragmatic rupture from Mar. 2003 to Aug. 2006 were reviewed retrospectively. Results： Exploratory thoracotomy and diaphragmatic repair were performed in these cases. 13 patients showed a left diaphragmatic rupture（61.9%） and 7 a left diaphragmatic rupture（33.3%）, and 1 both left and right diaphragmatic rupture （4.76%）. Bronchoscope was used in 3 patients with atelectasis after surgery, and tracheostomy was did in 2 patients since the failure of bronchoscope.20 cases were cured（95.24%）and 1 case died （4.76%）.The follow-up chest X-ray in all survival cases showed normal conditions without any pulmonary dysfunction. Conclusions： The correct diagnosis of traumatic diaphragmatic rupture should be made on time, and exploratory thoracotomy and diaphragmatic repair should be performed. Tracheostomy should be used in unconsciousness and expectoration failure patients to guarantee the airway clear and prevent pulmonary infection in the early stage after the operation.