创伤性膈疝13例治疗体会

目的：讨论外伤性膈疝的诊断和治疗方法。方法：回顾性分析我院1995年4月-005年6月间收治的外伤性膈疝13例的临床资料。结果：术前确诊10例，治愈12例。死亡1例。结论：临床经验不足是导致外伤性膈疝误诊、漏诊的主要原因。X线和CT检查在膈疝的诊断中有重要的作用。外伤性膈疝一经确诊，应立即手术治疗。     

创伤性膈疝32例分析

对我院1985～2000年创伤性膈疝32例分析如下。     

创伤性膈疝23例

因胸或胸腹部创伤导致膈肌破裂,腹腔脏器进入胸腔称为创伤性膈疝。我院于1985年4月～1999年8月共收治创伤性膈疝23例,现分析如下。 1 临床资料 23例中,男18例,女5例。年龄18～27岁。闭合性19例,开放性损伤4例。致伤原因:19例闭     

12例创伤性膈疝的诊治体会

膈肌创伤性破裂临床上较少见 ,仅占胸腹部创伤的 5 %左右 ,由于常合并其它脏器的损伤 ,给及时诊断带来困难 ,以致延误治疗。我院自 1978年～1998年共收治创伤性膈疝 12例 ,报告如下。1　资料与方法1.1　一般资料　本组男 9例 ,女 3例 ,年龄 7～ 70岁。病因 :坠落伤 3例、撞击伤 4例、挤压伤 3例、刀刺伤 2例。合并其它脏器损伤情况 :脾破裂 4例、脑挫伤 2例、多根肋骨骨折 3例、骨盆骨折 2例。膈肌均为线性损伤 ,长度 2～ 12ｃｍ。疝入胸腔的脏器中 ,单一胃 4例、胃、结肠、大网膜、脾脏 4例、单一肝脏 2例、几乎全部小肠 ,回盲部 ,升结肠 ,…     

创伤性膈疝诊治20例分析

创伤性膈疝并不罕见。临床常见急性创伤性膈疝和因急性期漏诊 ,发展至慢性间歇期创伤性膈疝两种 [1 ]。正确及时地诊断和处理是抢救患者提高存活率的关键。1　临床资料1.1　收集本院 1984- 12～ 2 0 0 0 - 12创伤性膈疝 2 0例 ,男 13例 ,女 7例 ,年龄 18～ 78岁 ,平均 36 .4岁。刀刺伤 5例 ,汽车撞伤 6例 ,挤压伤 2例 ,坠落伤 1例 ,其他手术史 4例 ,无明确外伤史 2例。急性间歇期创伤膈疝 12例 ,就诊时间 0 .1～ 30 h,慢性间歇期创伤性膈疝 8例 ,就诊时间 14d～ 30 a。其中 16例经手术证实诊断 (包括 2例 2次住院诊断、手术治疗 ) ,2例住院…     

创伤性膈疝13例诊治体会

我院自1994年9月至21304年12月共收治创伤性膈疝13例，现总结报告如下。     

创伤性膈疝28例诊治体会

创伤性膈疝多由严重的胸腹部损伤致膈肌破裂所致。由于常伴有合并伤,所以诊断较困难,往往造成漏诊或误诊。本文报告我院１９８０年～１９９８年收治２８例急性创伤性隔疝的诊治体会。１ 资料与方法１．１ 本组２８例中男２５例,女３例,年龄２１～６３岁,平均４１岁。左侧膈疝２６例,右侧膈疝２例。致伤原因：刀刺伤７例,交通事故１４例,坠落伤４例,其他挤压伤３例。合并肋骨骨折１６例,血气胸１７例,肺挫裂伤１４例,脾破裂７例,脊柱骨折６例,肾损伤３例,肝破裂３例,颅脑损伤４例,胃肠破裂伤４例。疝入横结肠１４例,胃６例…     

创伤性膈疝17例

创伤性膈疝因很少单独存在 ,加之对本病缺乏重视 ,故极易误诊、漏诊而延误治疗。近 10年来 ,我们曾遇 17例 ,讨论如下。1　临床资料1.1　一般资料　本组中男 14例 ,女 3例 ;年龄 15～ 5 6岁。受伤原因 :开放性伤 2例 ,闭合性伤 14例 ,1例为食管贲门癌手术膈肌缝合不全。受伤部位均为下胸部及中上腹部。膈肌破裂部位 :左侧 14例 ,右侧 3例。 17例均合并其它伤 ,主要是肋骨折 ,血气胸 ,骨盆骨折 ,胸腹内脏损伤 (胃、肺、肝、脾、结肠等 ) ,以及出血、创伤性休克等。受伤至手术治疗时间 :1～ 4年 4例 ,3～ 15天 3例 ,2 4小时以内 10例。1.2　临…     

创伤性膈疝5例临床分析

创伤性膈疝是一种易被延误诊断的疾病。膈肌损伤初期表现往往不典型,常因创伤所致的其它严重复合伤而被忽略,有潜在的、危险的并发症,故早期及时的诊断和处理十分重要。我院自1994～2005年收治膈肌损伤5例,现报告如下。     

影响创伤性膈疝或膈肌损伤病死率的危险因素分析——附51例报告

目的：探讨影响创伤性膈疝（traumatic diaphragmatic hernia,TDH）或膈肌损伤痛死率的危险因素。方法：收集51例TDH或膈肌损伤患者的临床资料,对死亡者（死亡组）与存活者（存活组）的临床资料进行对照研究,对12种相关因素进行统计学分析。结果：51例中,死亡9例,病死率为18％,死于早期（入院24h内）失血性休克4例,死于术后严重并发症5例,其中严重感染并ARDS2例、严重感染1例、ARDS1例、MODS1例。经统计学分析,2组间的年龄、损伤严重度记分分值、围手术期输血量、入院时有休克表现、术后并发症、入院时收缩压、脾脏损伤等级共7个因素的比较差异有统计学意义（均为P〈0．01）,经多因素回归分析,围手术期输血量等于或大于1400mL、脾脏损伤等于或大于Ⅲ级等2个危险因素是TDH或膈肌损伤死亡的独立预测指标（比数比分别为41、74,P〈0．05—0．01）。结论：TDH或膈肌损伤患者术前有严重合并伤尤其是脾脏严重损伤,围手术期大量出血或术后出现严重并发症,提示预后较差。     

创伤性膈肌破裂的诊断与治疗

目的探讨创伤性膈肌破裂早期诊断和治疗的方法。方法回顾性分析19例创伤性膈肌破裂的临床资料。闭合性损伤14例,开放性损伤5例。5例由胸部X线片确诊,11例由胸部CT确诊,3例经手中探查确诊。结果16例患者于术前得到确诊;18例患者经积极手术治疗均治愈,1例患者因严重肝破裂失血性休克死亡。术后并发出现肺不张1例,膈下脓肿1例,经积极治疗后治愈。结论增强对创伤性膈肌破裂的认识,详细采集病史及查体,通过胸部X线片或CT及时诊断和手术修补破裂的膈肌是提高治愈率及减低并发症的关键。     

MRI diagnosis of delayed presentation of traumatic diaphragmatic hernia

Traumatic rupture of the diaphragm may go unrecognized in patients with multiple injuries to the abdomen and chest. The majority of undiagnosed diaphragmatic ruptures will eventually become symptomatic and are associated with a high mortality rate if not treated immediately. Multiplanar imaging with magnetic resonance (MR) provided a definitive diagnosis of delayed presentation of traumatic diaphragmatic hernia.     

Strangulated traumatic diaphragmatic hernia simulating a subphrenic abscess

Traumatic diaphragmatic hernias can be difficult to diagnose because of their varied clinical and radiologic signs and because patients may not present with symptoms for months to years following the injury. We report a case of a delayed presentation of a traumatic diaphragmatic rupture through which a portion of the stomach herniated and simulated a large subphrenic abscess.     

创伤性膈肌损伤50例诊治分析

目的探讨创伤性膈肌损伤的早期诊断与治疗方法。方法对2002年2月至2009年3月收治的50例创伤性膈肌损伤患者的临床资料进行回顾性分析。结果 50例患者均为闭合性损伤,其中交通事故伤23例,高处坠落伤19例,挤压伤8例;术前经X线检查明确诊断23例,经CT检查明确诊断20例,7例经剖胸或剖腹探查时确诊;伤后24 h内手术34例,24 h～48 h手术6例;术前给予抗休克治疗并同时紧急行手术治疗,经胸手术38例,胸腹联合切口手术10例,经腹手术2例。术后发生全身炎症反应综合征(SIRS)导致器官功能障碍综合征(MODS)死亡3例,其余47例手术治疗出院,随访疗效满意。结论早期采用胸部X射线、CT检查结合临床表现综合诊断创伤性膈肌损伤是可行的,及时和正确地给予手术治疗是救治的关键。     

Delayed left traumatic diaphragmatic hernia repaired by laparoscopic surgery

A 77-year-old man injured himself when he fell heavily on the left side of his chest. He had massive subcutaneous emphysema, bleeding, and left hemopneumothorax. He also fractured his seventh through tenth ribs; a fragment of the ninth rib was displaced into the thoracic cavity. The severity of the damage and the patient's pain was assessed using the Abbreviated Injury Scale 1990 (1998 update) as level 3. He was treated with conservative therapy and discharged on the 16 days after the injury. However, the following day, he had acute upper abdominal pain, his blood pressure dropped to 40 s, and he was readmitted. A chest CT showed the transverse colon was prolapsed in the thoracic cavity. The patient was diagnosed as having a delayed traumatic diapharagmatic hernia. A laparoscopic repair was performed. The rupture was classified as a IIIb-type diaphragmatic injury according to the Japanese Association for the Surgery of Trauma's classification system. It is believed that a fragment of a fractured rib that had been displaced in the thoracic cavity ruptured the diaphragm sharply. Since traumatic diapharagmatic hernia rarely occurs, it is relatively difficult to diagnose at the first examination. This condition has a high mortality rate because of the associated injuries. Surgery is the only treatment, but it should only be considered after a second examination. Herein, I report my experience with a case of delayed diaphragmatic hernia repaired by laparoscopic surgery.     

Laparoscopic-assisted thoracoscopic repair of latent traumatic diaphragmatic hernia: A case report

Surgical approaches for traumatic diaphragmatic hernia include transabdominal, transthoracic, and thoracoabdominal. Selection of the optimal approach depends on the timing and organ damage, often minimally invasive approaches with laparoscopy or thoracoscopy are performed. A 47-year-old man with blunt chest trauma was diagnosed with left traumatic diaphragmatic hernia 1 month after the trauma. The prolapsed omentum was detached from the chest wall and around the hernia orifice and returned to the abdominal cavity by coordinated thoracoscopic and laparoscopic manipulations. The 4 × 2 cm herniation in the diaphragm was sutured closed from the thoracic side while preventing re-prolapse of the omentum and abdominal organs from the abdominal side. A combined thoracoscopic and laparoscopic approach can be effective in confirming organ damage, repositioning of prolapsed organs, and safe repair of the diaphragm in latent traumatic diaphragmatic hernia.     

Laparoscopic repair of traumatic diaphragmatic hernia with colon incarceration: A case report

Traumatic diaphragmatic hernia is a serious complication of blunt trauma to the abdomen or thorax. Although traumatic diaphragmatic hernia is treated with surgical repair, a laparoscopic approach is infrequently employed. Here we present the case of a 66-year-old man with a bruise on the left side of his back. CT revealed a left pneumothorax and left rib fractures. He was urgently hospitalized and relieved with conservative treatment. However, on day 4 of hospitalization, an incarcerated diaphragmatic hernia containing the transverse colon was observed on CT. The herniated viscera of the abdominal cavity were reduced laparoscopically, and the hernial orifice was repaired with direct closure. One-lung ventilation was used to limit the movement of the affected diaphragm, enabling effective laparoscopic suturing. The patient had an uneventful recovery period and was discharged 8 days postoperatively. The absence of diaphragmatic herniation recurrence was confirmed 6 months after surgery.     

Left diaphragmatic eventration diagnosed as congenital diaphragmatic hernia by prenatal sonography

Congenital diaphragmatic eventration is an abnormal elevation of the diaphragm resulting from failure of muscle fibers to develop during gestation. A mediastinal shift to the contralateral side may cause significant compression of the affected chest contents, resulting in compromised pulmonary function, especially when both sides are involved. Differentiating between congenital diaphragmatic eventration and congenital diaphragmatic hernia is very difficult but important because eventration has a better perinatal outcome than diaphragmatic hernia has. This report discusses a case of congenital diaphragmatic eventration that was initially diagnosed by prenatal sonography as a diaphragmatic hernia on the left side. In this case, the correct diagnosis was made at the time of surgery shortly after the infant's birth. The defect was repaired by plication, and the infant's outcome was favorable. Although the initial diagnosis was incorrect in this case, the use of sonography can aid in the prenatal detection and diagnosis of congenital diaphragmatic anomalies.     

新生儿先天性膈疝围手术期护理

总结9例先天性膈疝新生儿围手术期护理体会。根据新生儿的特点，认为注意监测和记录生命体征的变化，做好体位护理和胃管护理，加强保暖，保持内环境的平衡和改善营养状况，重视循环监测和呼吸管理等是围手术期护理的重要内容。