创伤性膈肌破裂及膈疝在诊断和治疗中应注意的问题

Watchful questions on diagnosis and treatment of traumatic diaphragmatic rupture and diaphragmatic hernia

目的探讨创伤性膈肌破裂及膈疝的临床特点及诊断和治疗中应注意的问题。方法对49例创伤性膈肌破裂和膈疝患者的临床资料进行回顾性分析。结果左侧膈疝32例，右侧膈疝13例，双侧膈疝4例。1例闭合性胸腹联合伤并休克患者，术后死于多器官衰竭；3例诊断超过24h；其余闭合性膈肌破裂和膈疝患者，于伤后24h内明确诊断，手术治愈。开放性膈肌破裂和膈疝患者，采用开腹探查术16例，5例漏诊需再次开胸手术；开胸探查术7例，2例术中改行胸腹联合切口手术；3例采用胸腹联合切口手术。一期治愈25例；1例合并化脓性肋软骨炎，病程长达13个月。结论创伤性膈肌破裂及膈疝易漏诊和误诊，术前制订合理的检查治疗方案可减少并发症，降低误诊率及病死率。

Objective To explore the clinical characteristics and the treatments on traumatic diaphragmatic rupture and diaphragmatic hernia. Method A retrospective study was carried out in 49 cases of traumatic diaphragmatic rupture and diaphragmatic hernia. Results There were 32 cases with left diaphragmatic hernia, 13 cases with right diaphragmatic hernia and 4 cases with bilateral diaphragmatic hernia. One case with dosed combined thoraco-abdominal wound and shock, died of muhiDle orzan failureafter the surgery, 3 cases were diagnosed more than 24 h after injury, the others closed injury patients were diaolosed within 24 h and cured. In patients with open diaphragmatic rupture and diaphragmatic hernia, 16 cases underwent laparotomy surgery, 5 cases of misdiagnosis experienced re-thoracotomy, 7 cases thoracotomy, 2 eases changed the thoraeo-abdominal surgery-. Three cases underwent thoraco-abdominal surgery. Twenty-five cases were cured; 1 patient with suppurative costal chondritis, duration up to 13 months. Conclusion Traumatic diaphragmatic rupture and diaphragmatic hernia is easily missed and misdiagnosed, the establish of rational examination preoperatively can reduce complications, misdiagnosis and mortality.