创伤性膈疝的诊治体会

目的总结创伤性膈疝的诊治经验。方法回顾分析34例创伤性膈疝病例,其中穿透伤7例,闭合伤27例。19例行X线检查,11例有阳性发现。9例进行CT检查,8例有阳性发现。手术治疗采用剖胸术9例,剖腹术23例,胸腹联合切口手术2例。结果术前确诊20例（58．8％）,手术探查确诊14例。治愈32例（94．1％）,死亡2例（5．9％）。结论CT和X线检查是诊断创伤性膈疝的主要诊断依据。早期诊断、及时手术是提高治愈率、降低病死率的关键。     

Late presentation of congenital diaphragmatic hernia

A boy aged 6 months and a girl aged 9 months were admitted due to vomiting, among others, and a boy aged 11 months due to pneumonia. It turned out that they had a congenital diaphragmatic hernia. Primary operative repair was performed successfully in all patients, followed by recovery. The older boy experienced a relapse nearly 1 year later, which was treated by surgical correction. Most congenital diaphragmatic hernias present directly after birth, with cyanosis and respiratory distress. However, 10-20% of the cases are discovered after this period. In these children diagnosis can be difficult because of the diverse symptoms such as vomiting, feeding difficulties, tachypnoea or recurrent respiratory tract infections. Physical signs include the absence of breath sounds or the presence of bowel sounds in the chest. Chest X-ray, contrast upper gastrointestinal series or ultrasound imaging confirms the diagnosis. Delay in treatment can lead to complications such as necrosis of the bowel. In young children with acute or chronic respiratory infections or gastrointestinal complaints, a congenital diaphragmatic defect should be considered.     

创伤性膈肌破裂及膈疝在诊断和治疗中应注意的问题

目的 探讨创伤性膈肌破裂及膈疝的临床特点及诊断和治疗中应注意的问题.方法 对49例创伤性膈肌破裂和膈疝患者的临床资料进行回顾性分析.结果 左侧膈疝32例,右侧膈疝13例,双侧膈疝4例.1例闭合性胸腹联合伤并休克患者,术后死于多器官衰竭;3例诊断超过24h;其余闭合性膈肌破裂和膈疝患者,于伤后24 h内明确诊断,手术治愈.开放性膈肌破裂和膈疝患者,采用开腹探查术16例,5例漏诊需再次开胸手术;开胸探查术7例,2例术中改行胸腹联合切口手术;3例采用胸腹联合切口手术.一期治愈25例;1例合并化脓性肋软骨炎,病程长达13个月.结论 创伤性膈肌破裂及膈疝易漏诊和误诊,术前制订合理的检查治疗方案可减少并发症,降低误诊率及病死率.     

创伤性膈疝的诊断与外科治疗

胸、腹部创伤所致膈肌破裂、腹腔脏器经膈肌裂孔进入胸腔形成创伤性膈疝.临床上缺乏特异性表现,而且多数同时存在胸、腹部或全身性复合伤,往往病情严重掩盖膈疝症状,容易误诊、漏诊.嵌顿、绞窄性膈疝若不及时处理可危及生命.胸、腹部暴力伤或锐器伤,都应警惕发生膈肌破裂和创伤性膈疝的可能.应注意早期诊断并及时处理才能提高创伤性膈疝救治成功率.     

先天性膈疝的诊断和外科治疗

先天性膈疝(congenital diaphragmatic hernia,CDH)是指腹腔内一部分脏器,通过膈肌先天性发育缺损开口,突入胸腔导致一系列症状的危重病症,是一种新生儿常见的严重畸形,为小儿急腹症之一.在成年人非常少见,在新生儿中发病率为1/5000～1/2500[1],根据发生部位不同可分为胸腹裂孔疝(多为左侧)、胸骨旁疝、食管裂孔疝等.大约40%CDH患儿合并有其他畸形,如肠转位不良、肺发育不良及先天性心脏病[2].     

重症先天性膈疝患儿的临床治疗策略

目的 探讨重症先天性膈疝(CDH)患儿的临床治疗策略.方法 选择2015年1月至2019年10月,西北妇女儿童医院小儿外科收治的7例重症CDH患儿为研究对象.采用回顾性研究方法收集受试儿一般临床资料、治疗、转归及术后随访结果等进行分析.本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求.结果 本组7...     

Therapeutic algorithm in cases with congenital diaphragmatic hernia of the Bochdalek type

The PURPOSE of the present study was to establish the treatment results of the applied approach for preoperative stabilization through mechanical ventilation and delayed surgical intervention as opposed to emergency surgical treatment in children with congenital diaphragmatic hernia. PATIENTS AND METHODS: Twenty-seven children have been treated (nine girls and 18 boys, twenty-four of them--newborns) over a ten-year period. The criteria for successful stabilization are arterial saturation of SaO2 90%, PaO2 = 90-100 mm Hg, PaCO2 40 mm Hg, pH 7.35. RESULTS: Twenty-five of the children were with left-sided hernia (92.59%) and only two (7.41%) with right-sided hernia. The stabilization period ranged from 1 to 4 days, mean 1.48 +/- 0.18 (Sx = 0.81). Preoperatively, in eighteen newborns we used conventional mechanical ventilation; in one child only we used high frequency oscillating ventilation. In three children we failed to achieve stabilization and after worsening of their condition they died before they could be operated. In all children, postoperative mechanical ventilation was applied from 3 to 16 days, mean 7 +/- 0.65 (Sx = 3.16). The mortality was 59.26%. CONCLUSIONS: The approach used for delayed surgical treatment has significant advantages compared to the urgent correction of the congenital diaphragmatic hernia. It provides opportunities for stabilization of the gas exchange and pulmonary circulation but still mortality remains high. New therapeutic techniques such as antenatal intervention or pulmonary transplantation are probably needed to save the lives of such patients.     

腹内疝的诊治现状先天性膈疝的诊断和外科治疗

先天性膈疝(congenital diaplaromatic hernia,CDH)是指腹腔内一部分脏器,通过膈肌先天性发育缺损开口,突入胸腔导致一系列症状的危重病症,是一种新生儿常见的严重畸形,为小儿急腹症之一.