创伤性膈肌破裂32例的临床诊断与治疗

目的探讨影响创伤性膈肌破裂临床诊断和治疗效果的因素。方法对本院收治的32例创伤性膈肌破裂患者的发病原因、部位、合并伤及损伤严重度评分、诊断经过及手术方法等分别进行分析。结果胸腹部开放性损伤为本组病人的主要损伤(75·0%),早期诊断或延迟诊断对病情的转归影响显著。合并伤的伤情严重度是决定患者死亡与否的重要因素之一。与早期确诊相比,延迟诊断病例的术后并发症增多,其发生率分别为5·3%与50·0%(P=0·072),平均住院时间分别为(9·6±1·5)d与(22·7±2·5)d,(P<0.01)。结论避免延迟诊断及选择正确的手术方法是提高抢救成功率的关键。

Diagnosis and Treatment of 32 Patients with Traumatic Rupture of Diaphragm

Objective To research the clinical diagnostic and therapeutic principles of traumatic rupture of diaphragm (TRD). MethodsClinical data of 32 patients with TRD treated in our hospital were reviewed. The related factors, including etiology, location, concomitant injuries, injury severity scale (ISS), diagnosis procedure and operative route, were analyzed. ResultsThe injury was often caused by penetrating trauma (75.0%). The injury severity of the concomitant injuries was considered as an important factor contributing to the death rate. If the diagnosis was delayed, the postoperative complication would increased distinctly when compared with that of those diagnosed early (50% VS 5.3%), and the mean hospital-staying duration was lengthened (22.7 2.5 VS 9.6 1.5) (P<0.01). ConclusionSuccessful treatment depends on early diagnosis and correct operative route.