25例创伤性膈疝的诊断与治疗体会

Diagnosis and Treatment of 25 Cases of Traumatic Diaphragmatic Hernia

目的总结创伤性膈疝的诊治经验。方法回顾性分析2005年7月-2009年5月25例创伤性膈疝的临床资料,其中开放性损伤6例,闭合性损伤19例。结果治愈23例,死亡2例(8%),1例死于失血性休克,1例多发伤首次手术中未探查而漏诊,1周后明确诊断再行剖胸手术后死亡。结论创伤性膈疝早期诊断极为重要,胸部X线与CT检查是诊断创伤性膈疝的重要方法,一经确诊应尽早手术治疗,因此早期诊断、及时手术、正确处理合并脏器伤是提高治愈率,降低病死率的关键。

Objective To summarize the diagnosis and treatment experiences of the traumatic diaphragmatic hernia. Methods The clinical data of 25 cases with traumatic diaphragmatic hernia from July 2005 to May 2009 were analyzed retrospectively. Among them,6 cases were open injures and 19 cases were closed injures. Results Twenty three cases were fully cured;2 cases died and the death rate was 8% , among them, 1 case died from hemorrhagic shock and 1 case died from multiple trauma which the patient was missed diagnosis in his first operation treatment. Conclusion The early diagnosis is most important for patients with traumatic diaphragmatic hernia. The most dependable diagnosis methods are chest fluoroscopy and CT examination. The traumatic diaphragmatic hernia operation should be performed as early as possible after diagnosis. The early diagnosis, timely operation and prompt treatment of associated organ injures are the key to improve the cure rate.