儿童急性闭合性创伤性膈肌破裂14例分析

ANALYSIS OF 14 CASES OF TRAUMATIC DIAPHRAGMATIC HERNIA IN CHILDREN

目的分析儿童急性创伤性膈肌破裂临床误诊率较高的原因，提高早期诊断率；方法回顾性分析２８６例儿童胸、腹外伤临床病历，记录临床表现，首诊误诊率（误诊例数／总例数×１００％）及术前误诊率等，并分析误诊原因；结果发现膈肌破裂１４列，首诊误诊率７１．４３％，术前误诊率３５．７１％。结论常有严重的合并症，临床表现差异大等是误诊率较高的原因；降低误诊率要重视膈肌破裂的临床表现，早期行胸腹Ｘ线检查和术中注意膈肌的探查。

Objective To study the causes of the higher rate of incorrect diagnosis of traumatic diaphragmatic hernia so that the rate of early diagnosis of the disease can be improved. Methods A retrospective analysis had been done on 286 children cases with thoracic and abdominal injuries complicated by traumatic diaphragmatic hernia. The clinical manifestation, the rate of first incorrect diagnosis (incorrect cases / total cases×100%), and incorrect diagnosis before operation were recorded. And the causes for incorrect diagnosis was analyzed. Results Fourteen cases of traumatic diaphragmatic hernia were found out. The rate of incorrect diagnosis at first and before operation were 71.43% and 35.71%, respectively. Conclusion Serious complications and greatly different manifestation are the causes of the higher rate of incorrect diagnosis; to decrease the rate of incorrect diagnosis we must pay attention to clinical manifestation, early x-ray examination of chest and abdomen, and exploration of diagram.