创伤性膈肌破裂27例分析

目的探讨创伤性膈肌破裂的致伤因素、诊断及手术方式。方法对27例创伤性膈肌破裂患者的临床资料进行回顾性分析与总结。结果本组术前确诊21例；术前未能确诊6例，误诊、漏诊率22．2％。均实施手术治疗，其中经胸手术22例，经腹手术2例，胸腹联合手术3例。26例痊愈出院，1例死亡；治愈率96．3％，病死率3．7％。结论膈肌的独特解剖结构及舒、缩状态时其在胸腔内位置的巨大变化，导致损伤时临床表现的多样性。胸部X线及CT检查是可靠的诊断方法。术前对创伤性膈肌破裂的高度警惕和术中仔细检查膈肌是减少漏诊的关键。及时手术是治愈创伤性膈肌破裂的有效途径。

Objective To discuss the diagnosis and surgical tratment of traumatic diaphragm rupture as well as the pathogenicfactors. Methods The clinical data of 27 patients with traumatic diaphragm rupture were reviewed and analyzed retrospectively. Results Before the operation were conducted, diagnoses of 21 cases were confirmed while diagnoses of 6 cases were not confirmed. The rate of misdiagnosis and missed diagnosis was 22.2%. Among all the patients were operated, 22 cases were operated via thoracic incision, 2 cases via abdominal incision and 3 cases were treated with trans - thoracic - abdominal approach. Among all ofthe 27 patients who were operated. 26 patients were cured, 1 patient died. Curative rate was 96. 3% while death rate was 3.7%. Conclusion The unique structure of diaphragm and the great changes of its positions in the thorax in the diastolic and systolic states lead to trauma and the variety of clinical manifestation. The thorax x - ray and CT are usually the key for reliable diagnosis. Being alert to the possibility of diaphragm injury before operation and careful inspection of the diaphragm at operation are the key in reducing misdiagnosis. Timely surgical operation is an effective approach to treat traumatic diaphragm rupture. Careful operations research is crucial to avoid missed diagnosis.