膈肌损伤诊治分析

The Diagnosis and Management of Diaphragmatic Injury:Experience with 34 Patients

目的 为探索膈肌损伤的早期诊断与治疗。方法 回顾分析了我院收治的 34例膈肌损伤 ,其中穿透性损伤 2 3例 ,闭合性损伤 11例。合并其它脏器 32例。经胸手术 12例 ,经腹手术 18例 ,胸腹联合切口 4例。结果 术前早期确诊 2 4例。早期手术 32例 ,死亡 2例 ,死亡率 5 9%。结论 胸部X线检查是首要的最可靠的诊断方法。CT、MRI和胸腔镜也是近年来报道逐渐增多的诊断手段。术前对膈肌损伤的高度重视及术中仔细检查膈肌是减少漏诊的关键 ,早期经腹手术是一种治疗膈肌损伤的较好的手术路径。

Objective:The aim of this retrospective note was to study some characteristics in diagnosis and management of diaphragmatic injury.Methods:Summarized the diagnosis and management 34 cases of diaphragmatic injury. Of the 34 cases,23 resuled from penetrating trauma and 11 due to closed injuries.32 cases had other associated injuries. Thoracotomy in 12 cases, laparotomy in 18 and combined thoracoabdominal incisions in 4.Results:The diagnosis was established preoperatively in 25 patients. The mortality rate was 5.9%,Conclusion:The symptoms and signs of visceral injuries were the important basis for diagnosing diaphragmatie injury early.Chest radiographs are the prinicipal and the most reliable method for making a diagnosis. The use of CT、MRI and thoracoscopy to diagnose patients with diaphragatic injury has been described increasingly. The key in reducing misdiagnosis is paying attention to the possibility of diaphragmatic injury before operation and careful inspection of the diaphragm at operation, initial laparotomy was a better operative approach for surgcial repair of diaphragmatic injury.