创伤性膈疝26例临床诊疗分析

Analysis of Clinical Diagnosis and Treatment of 26 Cases of Traumatic Diaphragmatic Hernia

目的探讨创伤性膈疝的临床诊断、手术治疗方法及效果。方法回顾分析我院收治的26例创伤性膈疝患者的临床诊治过程。结果该组26例患者中,19例经手术修补膈疝痊愈,1例因分离时损伤导致出血,1例膈肌损伤较大,难以直接缝合,2例先天性膈疝,1例陈旧性膈疝,因粘连严重不易分离,2例患者因疝入腹腔内脏器合并穿孔或有绞窄性坏死,胸腔污染严重,分别采取相应措施处理后膈疝缝合愈合良好。无再出血、腹膜炎或缝合口裂开、伤口不愈、感染等不良反应发生。结论创伤性膈疝结合胸腹部外伤症状、体征及胸部X线片、超声检查可早期确诊,根据患者疝入脏器情况选择合适手术路径多可获得较好的临床效果。

Objective To explore the clinical diagnosis and surgery method and effect of traumatic diaphragmatic hernia.Methods Retrospective analysis on the clinical diagnosis and treatment process of 26 cases of traumatic diaphragmatic hernia patients admitted to our hospital was done.Results Among the 26 patients,19 cases were cured by operation repaire,bleeding occurred in 1 case due to separation,the diaphragmatic muscle damage was too seious for direct suture,2 cases of congenital diaphragmatic hernia and 1 case of chronic diaphragmatic hernia,which was difficult to separate due to serious adhesion,in 2 cases with hernia into the abdominal cavity combined with perforation strangulation necrosis,severe chest pollution,corresponding measures were taken and the diaphragmatic hernia healed well.No rebleeding,peritonitis or suture place brust,wound disunion,infection or other adverse reaction happened.Conclusion Traumatic diaphragmatic hernia can be diagnosed early with the combination of thoracic and abdominal trauma symptoms,signs and chest X-ray,and ultrasound examination,selecting suitable surgery path according to with the hernia into viscera situation may get better clinical effect.