慢性潜伏期创伤性膈疝的诊断和治疗

目的探讨慢性潜伏期创伤性膈疝的诊断和治疗。方法收集1993-2013年陕西省人民医院经手术确诊的11例慢性潜伏期创伤性膈疝患者的诊治情况进行回顾性分析，探讨诊断及治疗的方法。结果11例患者有6例伤后1周内行胸部X线检查未发现膈疝，5例伤后无明显胸部症状未行胸部检查，潜伏期3～36年。术前均行胸部CT及X线胸片检查。术前经CT确诊6例，1例经消化道钡剂造影发现结肠疝入胸腔，4例术前诊断胸腔肿瘤或其他疾病。本组11例患者均行手术治愈。1例潜伏期较长且较大膈疝术后第三天因腹式剧烈咳嗽再次膈疝。择期行大补片修补术后治愈。随诊2～3年无复发，生活良好。结论慢性潜伏期创伤性膈疝患者，经仔细追问病史，结合胸部螺旋CT及膈肌三维重建，消化道钡剂造影检查多可明确诊断，及时手术并选择胸部入路，准备合适人工材料补片可获得良好效果。

THE DIAGNOSTIC METHODS AND TREATMENTS FOR CHRONIC AND LATENCY INTERVAL PHASE TRAUMATIC DIAPHRAGMATIC HERNIA

Objective To discuss the diagnostic methods and treatments for chronic latency patients with traumatic diaphragmatic hernia. Methods The data of 11 patients with interval phase traumatic diaphrag- matic hernia was collected from author＇s hospital since 1993 to 2013, The data had been analyzed to find the diagnostic methods and treatments. Results Chest X- ray had been examined for 6 of 11 patients in the first week after the traumas and no positive results had been discovered. The other 5 patients had not been examined by chest X - ray since they had no symptoms. The interval duration had lasted from 3 to 36 years. Thoracic computed tomography, chest X- ray, and other examinations were performed for all patients before operations. 6 of 11 patients had been diagnosed as interval phase traumatic diaphragmatic hernia by thoracic computed tomography, one patient had been diagnosed by the barium examination of digestive tract, and the other 4 patients had been diagnosed as thoracic tumor or other diseases. All the patients were cured after operations. One patient with the longer interval period had a recurrent diaphragmatic hernia in the 3rd day of post surgery because of severe cough, and he was cured after the second selective operation. All the patients had been followed - up for 2 to 3 years, and no recurrent hernia was detected. Conclusions Most of interval phase traumatic diaphragmatic hernia can be diagnosed by careful historytaking combined with imaging techniques such as thoracic computed tomography and barium examination of digestive tract. To taking prompt operations with thoracic incision may be a good treatment for it.