闭合性创伤性膈肌破裂的临床特点和诊治方法探讨

Clinical Features,Diagnosis and Treatment of Closed Traumatic Diaphragmatic Rupture Traumatic

目的:探讨闭合性创伤性膈肌破裂的临床特点及诊治方法。方法:选取2006年1月至2015年12月在我院治疗的67例闭合性创伤性膈肌破裂患者,回顾性分析患者临床特征等病历资料。结果:46.27%的患者表现为腹痛,41.79%表现为胸闷、呼吸困难,35.82%表现为胸痛,32.84%存在不同程度的腹膜炎体征,34.33%发生休克;CT诊断符合率为73.21%,明显高于术前X片和B超的43.75%和25.00%,差异比较有统计学意义(P<0.05)。结论:闭合性创伤性膈肌破裂的临床症状及体征不典型,治疗前要进行详细体格检查和影像学检查,其中CT对膈肌破裂的诊断价值高;确诊后要及时、合理选择手术方案,积极处理合并伤。

Objective:To explore the clinical features and diagnosis and treatment of closed traumatic diaphragmatic rupture.Methods:Selected 67 cases of closed traumatic diaphragmatic rupture in our hospital from Jan 2006 to Dec 2015,retrospective analysed patients with clinical features and others medical records.Results:46.27% of the patients presented with abdominal pain,41.79% showed chest tightness,dyspnea,35.82% showed chest pain,32.84% showed different degrees of signs of peritonitis,34.33% of the occurrence of shock;The diagnostic accuracy of CT was 73.21%,which was significantly higher than the 43.75% and 25% of preoperative X and B ultrasound,the difference was statistically significant(P < 0.05).Conclusion:The clinical symptoms and signs of closed traumatic diaphragmatic rupture are not typical,before treatment,should carry out a detailed physical examination and imaging examination,in which the value of CT in the diagnosis of diaphragmatic rupture is high;Should be timely,reasonable selection surgical program,and actively deal with the combined injury.