成人膈疝18例诊断分析

Diagnostic Analysis of 18 Patients with Adult Diaphragmatic Hernia

目的：探讨成人膈疝的临床特点。方法：结合文献对1992年-2012年中山大学孙逸仙纪念医院收治18例成人膈疝的临床表现、影像学特点、诊断、误诊情况及医源性损伤进行分析。结果：14例行胸部x线检查的患者中仅1例提示膈疝，其余均出现类似其他疾病的表现，未能正确诊断。通过特异性体征、上消化道造影和／或胸部CT及MR检查术前提示膈疝诊断17例，均经手术证实诊断。1例以肿块为表现的患者须经手术明确诊断。5例在诊治过程早期出现误诊。1例经皮肺穿刺检查，但未能明确。结论：影像学中位于膈上、膈旁及涉及膈肌的病变应警惕膈疝，钡剂或其替代物检查、胸部CT及MR可为膈疝的及早诊断提供有效的帮助，对疑为膈疝的患者应避免有创性穿刺检查。

Objective：To explore the clinical characteristics of adult diaphragmatic hernia. Methods：The clinical data of 18 patients with adult diaphragmatic hernia from 1992 to 2012 were analyzed retrospectively, and the literatures were reviewed with regard to its clinical manifestation,imaging feature,misdiagnosis,diagnosis and iatrogenic complications.Results： 14 cases underwent chest X-ray examination but only 1 case was revealed to have diaphragmatic hernia. While the other 13 cases showed manifestations similar to other diseases and incorrete diagnosis were made. Diagnosis of 17 cases had been made before operation through specific clinical signs, barium and its substitute examination of gastrointestinal tract and/or chest CT or MR. Only 1 case needed to he diagnosed through operation. 5 cases were misdiagnosed in the early stage of the therapy. Percntaneous lung puncture had been taken in 1 case but could not be diagnosed correctly. Conclusion： Similar manifestation is a very common phenomenon in diaphragmatic hernia which can lead to misdiagnosis. So we should pay attention to the alteration involved with or nearly to the diaphragm. Barium or its substitute examination, chest CT and MR are effective methods for diagnosis. Traumatic puncture procedure should be avoided in patients who are suspected to have diaphragmatic hernia.