创伤性膈疝66例临床诊治分析

目的　总结创伤性膈疝的早期诊断方法 ,减少误诊 ,提高外科治疗水平。方法　回顾性分析 1 980 - 0 1～1 999- 1 2三家医院收治的 6 6例创伤性膈疝的临床病例资料。结果　伤后 2 4h内确诊 2 4例 ,术前确诊 48例 ,94%的患者合并其他脏器损伤 ,手术采用剖胸术 2 2例 ,剖腹术 39例 ,剖胸并剖腹 5例 ;治愈 6 2例 ,死亡 4例 ,死亡率 6 .1 %。结论　创伤性膈疝早期易误诊、漏诊 ,胸部 X线检查非常重要 ,早期诊断、及时手术、选择适当的手术方式、正确处理合并伤、重视整体治疗是提高治愈率的关键。

Diagnostic and Therapeutic Analysis of 66 Cases of Traumatic Diaphragmatic Hernia

Objective To sum up the experiences in early diagnosis of traumatic diaphragmatic hernia,reduce the rate of misdiagnosis and improve the level of surgical treatment.Methods The clinical data of 66 patients of traumatic diaphragmatic hernia from January 1980 to December 1999 were analyzed retrospectively.Results 24 cases were correctly diagnosed in 24 hours after traumas.The diagnosis was established before operation in 48 cases.94% of the patients had other associated injuries.Thoractomy was used in 22 cases and laparotomy in 39 cases.5 cases were required thoractomy and laparotomy in the same time.62 patients were cured and 4 died (6.1%).Conclusion Misdiagnosis is quite frequently in the early phase of traumatic diaphragmatic henia .Chest X ray plays an important role in making a correct diagnosis. Early diagnosis , prompt operation, choosing the suitable operation method,timely and correct treatment of associated injury are all important factors to improve the cure rate and reduce mortality.