创伤性膈疝的诊断与治疗

创伤性膈疝的诊断与治疗蓝斌李木泉林有光罗友雄创伤性膈疝是一种少见、易被延误诊断的疾病。我科自１９８３年～１９９５年１２月共收治１６例，现报告如下。１临床资料与方法１．１一般资料本组１６例中，男性１１例，女性５例。年龄１８～６５岁，＜４０岁１３例，占８...     

创伤性膈疝的诊断和治疗

目的 总结创伤性膈疝的诊治经验。方法 回顾性分析自１９７２年１月至１９９８年８月４家医院收治的８５例创伤性膈疝,其发生原因为穿透性损伤４３例,闭合性损伤４２例,９５．３％的病人合并其它脏器损伤。手术治疗采用剖胸术１１例,剖腹术７２例,剖腹后剖胸术２例。结果 术前确诊５８例,全组治愈７８例,死亡７例,病死率８．２％。     

闭合创伤性膈疝的诊断

目的 回顾分析闭合创伤性膈疝的诊断经验。方法 对1976年6月～2004年10月所收治的闭合创伤性膈疝22例进行回顾性分析。结果 闭合创伤性膈疝的病因以交通事故最多见，占77．3％，术前诊断明确15例，确诊率68．2％。全组治愈20例，治愈率90．9％。2例因多脏器功能衰竭死亡，病死率为9．1％。随访15例，随访率为71．4％，均无复发。结论 早期诊断的措施包括提高对闭合创伤性膈疝的认识，动态观察病情变化，及时复查胸部平片，电视辅助下胸、腹腔镜诊断性检查。     

创伤性膈疝6例误诊分析

创伤性膈疝６例误诊分析青岛医学院第二附属医院心胸外科（２６６０４２）刘子良，王青山青岛市交通医院外科（２６６０１２）刘旭作者自１９８１年３月至１９９４年１１月间，共收治创伤性膈疝１０例。其中６例延误诊治，本文就其误诊原因分析如下。１临床资料本组６例，...     

创伤性膈疝的诊断

目的 总结创伤性膈疝诊断的经验教训,探讨提高早期诊断率的方法。方法 对４４例创伤性膈疝临床资料进行回顾性分析。结果 术前确诊１６例（３６．３６％）,误诊２８例（６３．６４％）,其中术中漏诊４例,全组治愈３２例（７２．７３％）、死亡１２例（２７．２７％）。结论 创伤性膈疝易于误诊,术前确诊率低,其原因是：对该病认识与警惕不够,该病缺乏特有症状。因此,提高对该病的认识,动态观察病情,全面分析其临床表现     

创伤性膈疝的临床诊断与治疗分析

目的对创伤性膈疝的临床诊治方案进行总结和研究,探讨最有效的诊断措施和最佳治疗方法。方法对商丘市第一人民医院胸外科收治的40例创伤性膈疝患者的临床诊断和治疗情况进行回顾性分析。结果本组患者经临床治疗后,38例手术顺利,痊愈出院,治愈率为95%.2例患者死亡,病死率为5%。结论创伤性膈疝在胸腹部创伤患者中发生率较高,由于创伤复杂常被其他症状覆盖,诊断较为困难。早期诊断及时手术是治疗成功的关键。     

创伤性膈疝的诊断

创伤性膈疝无特异性的临床表现,常合并有胸腹腔脏器或其它重要脏器的严重损伤,大多数受创者死于事故的现场。能就诊于临床者又易被合并伤的症状和体征所掩盖而导致误诊和漏诊,影响了抢救措施的合理实施和手术途径的选择,故如何在早期或术前明确诊断就显得尤为重要。本文回顾总结本院1990年至2001年,收治的11例创伤性膈疝的临床资料,报道如下。1临床资料1.1一般资料:本组11例,男7例,女4例;年龄8～57岁。伤后入院时间,1小时内5例,1～2小时内3例,2～6小时内3例。致伤原因,车祸伤6例,坠落伤2例,矿石挤压伤2例,船绞绳盘柄回弹击伤1例,11例全为左…     

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目的 总结膈肌破裂和创伤性膈疝的诊治方法。方法 回顾性分析16例创伤性膈肌破裂和膈疝病例,其中穿透伤6例,闭合伤10例,16例进行X线检查。9例有阳性发现,8例进行CT检查。均为阳性,结果 术前确诊12例（75.0%),治愈14例,死亡2例（12.5%)。结论 CT和X线检查是诊断膈肌破裂和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。     

创伤性膈疝的诊断和治疗

为了理解创伤性膈疝的临床表现、诊断要点、手术方法和预后结果,本文回顾性的分析了我院收治的11例创伤性膈疝,强调指出创伤性膈疝因常常伴有其他严重合并伤,又缺乏典型的临床表现,常导致误诊。胸部平片和胃肠造影对本病的诊断有很大帮助。本病一经确诊,均应尽早手术,经胸部切口手术适于绝大多数病人。预后主要取决于合并伤的严重程度。     

创伤性膈疝28例诊治分析

目的 分析创伤性膈疝的诊治过程,总结早期诊断经验和漏诊原因,探讨治疗方法。方法 回顾分析我院2002.01~2011.10收治的创伤性膈疝患者28例病例资料。结果 本组27例患者痊愈出院,1例合并严重颅脑损伤和腹腔脏器破裂出血死于休克后多脏器功能衰竭。8例合并较严重肺挫伤患者并发呼吸衰竭,呼吸机辅助呼吸后痊愈出院。胸部切口均为甲级愈合,腹部切口感染2例,其中1例全层裂开,II期减张缝合后痊愈出院。1例局部处理后痊愈。24例随访1年,无复发,失访3例。结论 创伤性膈疝一经确诊应尽早手术治疗,同时高对创伤性膈疝发生机制的认识,减少误诊。     

创伤性膈疝28例临床分析

目的总结创伤性膈疝的诊治经验。方法回顾分析1990年1月～2004年8月28例创伤性膈疝临床资料。其中开放性损伤7例,闭合性损伤21例。结果术前确诊19例（67．9％）,治愈25例。死亡3例（10．7％）,2例死于出血性休克,1例死于多器官功能障碍综合征（MODS）。结论胸部X线和CT检查是诊断创伤性膈疝的重要方法。早期诊断、及时手术,正确处理合并脏器伤是提高治愈率的关键。     

Intrapericardial diaphragmatic hernia: a rare type of congenital diaphragmatic hernia

An extremely rare case of congenital intrapericardial diaphragmatic hernia is presented. Since 1981, only 14 cases have been reported in the literature. A 5-year-old girl presented with dyspnea on exertion and easy fatigability. Computed tomography was suggestive of an anterior diaphragmatic hernia. Laparoscopy followed by successful open repair of hernia was performed.     

Thoracolaparoscopic repair of diaphragmatic hernias

Complex long-standing diaphragmatic hernia presenting in adults is often managed through an open approach. Minimal invasive approach by either laparoscopy or thoracoscopy is limited by its ability to tackle these complex hernias with large defects and thoraco-mediastinal adhesions. Thus, standard laparoscopic or thoracoscopic approach is associated with high conversion to open approach. We herein describe a novel combined thoraco-laparoscopic approach to repair complex diaphragmatic hernias in a series of three adults.     

Right congenital diaphragmatic hernia: an 18-year experience

Background

Prenatal diagnosis and outcome of right congenital diaphragmatic hernia (RCDH) are far less well known than the more common left CDH (LCDH). In addition, onset of RCDH beyond the neonatal period with a spectrum of atypical symptoms is not unusual. A retrospective analysis of RCDH treated at a single center over 18 years has been reviewed with regard to outcome after the introduction of a new treatment protocol for CDH.

Methods

All charts of patients with CDH between 1987 and 2004 were reviewed. Twenty-nine patients with RCDH were identified. The patients were divided into 2 historical groups: group 1, from 1987 to 1998 (16 patients), and group 2, from 1999 to 2004 (13 patients). From 1999, at the Department of Pediatric Surgery of Padua, the management of a baby born with CDH has been standardized and includes planned delivery at term, high-frequency oscillatory ventilation since birth, inhaled nitric oxide if required, extracorporeal membrane oxygenation as a “last resort,” and delayed repair once the infant is hemodynamically stable. Patients with either prenatal diagnosis of RCDH or early onset of symptoms (<6 hours of life) were considered “high risk,” and those with late onset (>6 hours) were considered “low risk.”

Results

Of 29 patients, prenatal diagnosis was available in 8 (27.5%) and major associated malformations in 8 patients (27.5%). Eight (50%) of 16 cases from group 1 and 9 (69.2%) of 13 cases from group 2 were high-risk patients. There was a trend in favor of a higher survival among high-risk patients from group 2 (25% vs 44%), although this was not statistically significant. As expected, all low-risk patients survived (P = .0001). Plain thorax x-ray was diagnostic in 23 (82.1%) cases, initially normal in 3, not performed in 1, and misinterpreted as right lower lobe pneumonia in 2. At operation, the prosthetic patch was required in 2 (9%) of 22 cases and the peritoneal sac was found in 4 (13.7%).

Conclusions

(1) The rate of prenatal diagnosis of RCDH was low and remained stable throughout the examined period. (2) The introduction of a treatment protocol, using high-frequency oscillatory ventilation since birth, improved the survival of high-risk patients with RCDH, although the data did not reach statistical significance. (3) The majority (75%) of low-risk patients presented beyond the first week of life with a variety of aspecific gastrointestinal or respiratory symptoms that accounted for initial misdiagnosis. (4) Even in these cases, the outcome was excellent.     

“Acquired” congenital diaphragmatic hernia

“Acquired” congenital diaphragmatic hernia (ACDH), has been defined as delayed or late appearance of a congenital diaphragmatic hernia after a documented time period of postnatal life with no evidence of herniation. Three new cases are presented. This diagnosis has been characterized on the basis of a review of these cases and 14 additional patients from the literature. A classification based upon timing of herniation and state of pulmonary development is presented.     

Right-sided traumatic diaphragmatic hernia

A case of post-traumatic diaphragmatic hernia on the right side in a 18-month-old child is presented. The hernia followed trivial blunt trauma sustained two months earlier. The hernia was successfully repaired by thoracotomy. The condition is rare on the right side. Diagnosis depends on clinical suspicion and skiagrams of the chest. The relevant literature is reviewed.