创伤性膈肌损伤的诊断及治疗

目的 探讨创伤性膈肌损伤的早期诊断及手术入路选择。方法 回顾性分析近10年来收治的23例创伤性膈肌损伤患者的临床资料。结果 术前诊断12例(52．2％)；术中确诊8例(34．8％)；漏诊3例，漏诊率为13．1％。全组患者均经手术治疗，经胸手术12例，经腹手术8例，胸腹联合切口手术3例。术中见腹腔内脏器疝人胸腔18例，单纯膈性肌损伤5例。术后并发脓胸2例。死亡3例，死亡率13．1％，死亡原因为失血性休克和多器官功能衰竭。结论 创伤性膈肌损伤早期诊断困难，关键是要考虑到膈肌损伤。创伤性膈肌损伤一经诊断或怀疑其可能时，应及早手术治疗。要根据受伤机制、受伤部位，选择手术入路，并根据术中发现选择手术方式。

Diagnosis and treatment of traumatic diaphragma rupture

Objective To explore the early diagnosis and optimum operative approach of traumatic diaphragma rupture (TDR) . Methods The clinical dada of 23 patients with TDR admitted to our hospital in recent 10 years were retrospectively analyzed. Results The diagnosis of TDR was made before operation in 12 cases1 (52.2%), and intraoperation in 8 (34.8), and misdiagnosed in 3 cases (13.1%). All the 23 patients underwent operation. Of the 23 patients, the operation was performed via thorax approach in 12 patients , via abdominal approach in 8, and via thorax-abdominal approach in 3. Hernation of the abdominal viscera into the thorax was observed in 18 cases, and single TDR in 5 cases.Empyema occurred after operation in 2 patients. 3 cases(13.1%) dead of hypovolemic shock and multiple organs failure. Conclusions The diagnosis of TDR may be difficult. The key of the diagnosis of TDR is to think of it. Once the diagnosis is made or suspected, the operation should be taken as early as possible. The choice of operative approach should be according to the injury mechanism and location; the choice of the operative procedure should be according to the intraoperative findings.