创伤性膈肌损伤50例诊治分析

Diagnosis and treatment of 50 patients with traumatic diaphragmatic rupture

目的探讨创伤性膈肌损伤的早期诊断与治疗方法。方法对2002年2月至2009年3月收治的50例创伤性膈肌损伤患者的临床资料进行回顾性分析。结果 50例患者均为闭合性损伤,其中交通事故伤23例,高处坠落伤19例,挤压伤8例;术前经X线检查明确诊断23例,经CT检查明确诊断20例,7例经剖胸或剖腹探查时确诊;伤后24 h内手术34例,24 h～48 h手术6例;术前给予抗休克治疗并同时紧急行手术治疗,经胸手术38例,胸腹联合切口手术10例,经腹手术2例。术后发生全身炎症反应综合征(SIRS)导致器官功能障碍综合征(MODS)死亡3例,其余47例手术治疗出院,随访疗效满意。结论早期采用胸部X射线、CT检查结合临床表现综合诊断创伤性膈肌损伤是可行的,及时和正确地给予手术治疗是救治的关键。

Objective To explore the method for early diagnosis and treatment of patients with traumatic diaphragmatic rupture（TDR）.Methods The clinical data of 50 patients with TDR during February 2002 to March 2009 were retrospectively analyzed.Results All these patients were suffered from closed blunt trauma,including 23 cases of traffic accident injury,19 cases of injury caused by falling from height and 8 cases of crush injury;23 cases were diagnosed by X-ray examination,20 cases were diagnosed by CT scanning,and 7 cases were diagnosed by thoracotomy or laparotomy.Surgery was given within 24 h after injury in 34 cases and within 24h^48h in 6 cases.Before operation,all these patients were given with anti-shock treatment,then they were treated with emergency surgery at the same time.Thoracic surgery was taken in 38 cases,thoracoabdominal surgery was carried out in 10 cases and abdominal surgery was taken in 2 cases.After surgery,3 cases died of systemic inflammatory response syndrome（SIRS）leading to multiple organ dysfunction syndrome（MODS）,47 patients recovered and discharged with satisfactory follow-up.Conclusion The chest X-ray radiographs,CT scanning and clinical manifestations are principal methods for diagnosis of TDR.Timely and proper surgical treatment is the key for successful treatment of patients with traumatic diaphragmatic rupture（TDR）.