创伤性膈疝的诊断

Diagnosis of traumatic diaphragmatic hernia

目的 总结创伤性膈疝诊断的经验教训 ,探讨提高早期诊断率的方法。方法 对 44例创伤性膈疝临床资料进行回顾性分析。结果 术前确诊 1 6例 (36 36% ) ,误诊 2 8例(63 64% ) ,其中术中漏诊 4例。全组治愈 32例 (72 73% ) ,死亡 1 2例 (2 7 2 7% )。结论 创伤性膈疝易于误诊 ,术前确诊率低 ,其原因是 :对该病认识与警惕不够 ;该病缺乏特有症状。因此 ,提高对该病的认识 ,动态观察病情 ,全面分析其临床表现及X线征象是提高早期诊断的重要途径。B超、人工气腹及胸腔镜检查对确定诊断有重要意义。

Objective To summarrize the experience in diagnosis of traumatic diaphragmatic hernia and investigate a method for improving the early diagnostic rate. Methods The clinical data of forty four cases of traumatic diaphragmatic hernia were restropectively analysed. Results 16 cases(36.36%) were preoperatively diagnosed, 28 cases(63.64%) maldiagnosed, including 4 cases of maldiagnosis during explore laporatomy. 32 cases(72.73%) were cured and 12(27.27%) died. Conclutions Traumatic diaphragmatic hernia is easy to be misdiagnosed preoperatively. The causes of misdiagnosis including: ⑴ Lack of the knowledge of the disease; ⑵ Lack of special symptoms of the disease. So increasing knowledge and dynamic observation of the disease as well as an analysis of its clinical manifestation dialectically are important for improving the early diagnosis. B ultrasonography, artificial pneumoperitoneum examination and thoracoscopy are benefitial to help correct diagnosis.