创伤性膈疝25例临床诊治体会

Experiences of Clinical Diagnosis and Treatment of Traumatic Diaphragmatic Hernia (A Report of 25 Cases)

目的总结创伤性膈疝的临床诊断和早期治疗的经验,为减少误诊、漏诊及提高治愈率提供参考。方法对25例创伤性膈疝患者的临床资料与治疗经验进行总结分析,21例于伤后24 h内就诊,3例于伤后48h就诊;1例CT检查发现空腔脏器疝入胸腔,追问病史,2年前有外伤史。术前均完善胸片、胸腹部CT和胸腹部B超检查,术前均获确诊,确诊率100%。采用经胸手术14例,经腹手术8例,胸腹联合切口3例。疝内容物为肝3例,脾6例,胃7例,大网膜4例,结肠2例,其他3例。同时行肝修补术3例,行脾切除术6例,行胃肠破裂修补术13例。结果术中发现左侧膈疝23例,右侧膈疝2例。膈肌呈线性破裂20例,呈不规则破裂5例。膈肌破裂长度平均为7.6(4～16)cm。治愈23例,死亡2例,病死率8%。23例均获随访,平均随访时间28.5(6～40)个月,未见膈疝复发。结论创伤性膈疝多发生于严重胸腹部损伤,缺乏特异性临床表现,一经确诊应尽早手术治疗。修补膈肌裂口,及时正确地处理合并脏器伤是提高治愈率,降低死亡率的关键。

Objective To summarize the experiences of the clinical diagnosis and treatment of traumatic diaphragmatic hernia. Methods The clinical data in 25 cases of traumatic diaphragmatic hernia were analyzed retrospectively. There were 21 cases received a medical examination within 24 hours after injury, while 3 cases were treated within 48 hours. And one case was discovered 2 years later by the CT examination. All the patients were definitely diagnosed before operation, and the definite diagnosis rate was 100%. The hernia contents includ- ed 3 cases of liver, 6 of spleen, 7 of stomach, 4 of greater omentum, 2 of colon and etc. And some other proce- dures were performed such as liver repair in 3 cases, splenectomy in 6 cases and gastro-intestinal rupture repair in 13 cases. Results Left diaphragmatic hernia was found in 23 cases in the operation and the other 2 cases of diaphragmatic hernia was on the right side. Linear rupture of diaphragm was found in 20 cases, and 5 cases of irregular rupture. Diaphragmatic rupture length averaged 7.6 （4 ～ 16 ） cm. There were 23 cases （92%） cured and 2 cases （8%） died after operation. During the follow-up of an average time of 28.5 （6 ～ 40） months, no diaphragmatic hernia recurrence occurred. Conclusions The traumatic diaphragmatic hernia occurs in the serious chest abdomen damage, lacks of specificity clinical manifestation. It is the key points of patching the diaphragm rupture and promptly correcting the merge internal organ injuries to enhance the cure rate and reduce the mortality rate.