48例创伤性膈肌破裂的诊治体会

目的　探讨创伤性膈肌破裂的诊断与治疗。方法　对我院 1976年 6月～ 2 0 0 3年 2月收治的创伤性膈肌破裂病人进行了回顾性分析。结果　本组病人的临床表现复杂 ,大多数缺乏特征性征象。 4 8例中术前明确诊断的仅 2 0例 ,确诊率 4 1.7%。全组死亡 2例 ,死亡率 4 .2 %。结论　创伤性膈肌破裂多数为左侧 ,主要损伤机制是刃器伤和钝性伤。根据症状、体征 ,结合胸部X线、上消化道造影、CT、人工气腹等检查 ,能提高诊断率 ;膈肌破裂一经确诊 ,应手术治疗 ;根据胸、腹脏器损伤的情况 ,选用手术切口     

创伤性膈肌破裂的诊治体会

对18例创伤性膈肌破裂临床资料进行回顾分析,术前确诊15例,治愈15例,死亡3例。及时手术探查并修补膈肌裂口是创伤性膈肌破裂的首选手术方法,围手术期大量出血或术后严重并发症患者预后较差;正确处理并发症是提高其治愈率的关键。     

创伤性膈肌破裂的诊治体会

分析1982—01--2002—01间76例创伤性膈肌破裂的临床资料。结果提示多种因素的影响造成创伤性膈肌破裂的早期诊断，多种检查方法的综合应用、连续观察是早期诊断创伤性膈肌破裂的关健。治疗上应采用以手术为主的综合治疗方法。     

创伤性膈肌破裂的诊断与治疗

对23例创伤性膈肌破裂的致伤机制、临床表现、辅助检查、手术方法进行了回顾性分析。术前确诊15例、术中发现8例;手术治愈21例、死亡2例。创伤性膈肌破裂易被合并伤掩盖,发生膈疝极易绞窄,早期诊断及时手术尤为重要。     

创伤性膈肌破裂14例临床分析

创伤性膈肌破裂(traumatic diaphragmaticrupture,TDR)多由胸腹钝挫伤或穿通伤所致,对伤员危害十分严重,且早期常不易做出诊断而漏诊。作者总结了近10年(1984～1994)来收治的创伤性膈肌破裂14例,并重点分析了创伤性膈肌破裂的早期诊断及漏诊原因。     

创伤性膈肌破裂的急救处理

总结创伤性膈肌破裂的急救处理经验。回顾23例患者急救及手术方法,23例中治愈出院22例,死亡1例。笔者认为详细了解伤情、确定诊断、及时治疗合并伤是救治创伤性膈肌破裂的关键。     

创伤性膈肌破裂合并心包破裂1例

本文报告1例较罕见创伤性膈肌破裂合并心包破裂,该类病例术前易漏诊,最终经剖胸手术明确诊断并治愈。讨论了创伤性膈肌破裂漏诊原因及治疗方式。     

创伤性膈肌破裂的诊断与治疗(附20例分析)

目的:探讨创伤性膈肌破裂与膈疝的诊断与治疗.方法:对该院收治的20例创伤性膈肌破裂进行回顾性分析.结果:20例中开放性损伤7例,闭合性损伤13例,17例合并膈疝,X线检查10例有阳性表现,6例行胸部CT检查均为阳性,术前确诊16例,术中确诊4例,治愈19例(95%),死亡1例(5%).结论:X线和CT检查是诊断膈肌破裂和创伤性膈疝的主要依据,胸腹联合伤应警惕创伤性膈肌的损伤,应注意受伤的原因、体位、及外力作用的方向,早诊断,及时手术是提高治愈率、降低死亡率的关键.     

创伤性膈肌破裂

总结创伤性膈肌破裂的诊断和治疗经验。分析致伤原因、手术方式、误诊教训。认为胸腹部创伤要注意致伤原因、创伤部位等因素;胸部X线透视是可靠的检查方法;手术应仔细检查膈肌;创伤性膈疝应尽快手术治疗。     

45例创伤性膈肌破裂的临床诊治

创伤性膈肌损伤的早期诊断和治疗方法存在争论，而早期诊断创伤性膈肌损伤仍然较为困难。遗漏创伤性膈肌损伤将导致疝，严重者易发生疝嵌顿、坏死等严重后果。我院自1997年1月至2005年9月共收治创伤性膈肌破裂45例。现分析报告如下。     

34例创伤性膈肌破裂的早期诊断和外科治疗

目的总结创伤性膈肌破裂（TDR）的早期诊断和外科治疗的临床经验。方法回顾性分析1995年1月-2006年12月我院收治的34例创伤性膈肌破裂（TDR）患者的临床资料，对其发病原因、合并伤、诊断及手术途径分别进行分析。结果34例术前确诊14例，治愈32例，死亡2例。结论早期诊断和积极治疗是救治创伤性膈肌破裂的关键。     

34例创伤性膈肌破裂的早期诊断和外科治疗

目的 总结创伤性膈肌破裂(TDR)的早期诊断和外科治疗的临床经验.方法 回顾性分析1995年1月～2006年12月我院收治的34例创伤性膈肌破裂(TDR)患者的临床资料,对其发病原因、合并伤、诊断及手术途径分别进行分析.结果 34例术前确诊14例,治愈32例,死亡2例.结论 早期诊断和积极治疗是救治创伤性膈肌破裂的关键.     

创伤性膈肌破裂的表现及诊治中值得注意的问题

目的探讨创伤性膈肌破裂(TDR)的表现及诊治中值得注意问题。方法笔者回顾性分析1980年1月~2015年1月收治TDR 54例的临床资料,男性43例,女性11例;年龄7~68岁,平均(36±16.2)岁。左侧膈肌破裂48例,右侧6例。开放性、闭合性膈肌破裂膈疝发生率各为10.0%(1/10)和90.9%(40/44)(P0.01)。结果患者伤后或入院24h内未能确诊31例占57.4%,院内、外延误诊断率各为14.8(8/54)%和42.6%(23/54)(P0.01);X线、CT、B超对膈疝的检出率各为51.4%(19/37)、87.5%(28/32)和56.3%(9/16),其中23例经2种以上检查手段确诊,CT组与X线、B超组比较差异均有统计学意义(P0.05);41例膈疝术中证实均难自行还纳,其中29.3%与胸腔形成粘连,9例因疝入脏器破裂或绞窄、坏死行手术修补或切除。本组治愈51例(94.4%),因创伤性休克、重型颅脑损伤合并多器官功能衰竭死亡3例(5.6%),其ISS平均值为42.4分。结论伤后出现胸腹双腔症/症候群和膈疝影像学特征是诊断TDR的主要依据,早期诊断、合理选择手术方法、积极处理合并伤是临床关注的重点。     

多层螺旋CT多平面重组诊断创伤性膈肌破裂

目的 探讨MSCT MPR方法诊断创伤性膈肌破裂(traumatic diaphragmatic rupture,TDR)的价值.方法 21例手术证实TDR,15例排除TDR的胸腹部创伤患者术前MSCT图像,由3名高年资医师先后对MSCT横断面和MPR图像行盲法回顾分析,以发现横膈异常升高、膈肌中断缺损及"颈圈征"作为TDR诊断依据.对照手术结果计算MSCT横断面及MPR诊断TDR的敏感度、特异度、阳性预测值、阴性预测值和准确度;MSCT横断面和MPR对膈肌中断缺损、"颈圈征"的辨认率差异及其诊断TDR的敏感度、特异度差异采用McNemar检验.结果 MSCT横断面诊断TDR的敏感度、特异度、阳性预测值、阴性预测值和准确度分别为71%(15/21)、80%(12/15)、83%(15/18)、67%(12/18)和75%(27/36);MPR分别为86%(18/21)、93%(14/15)、95%(18/19)、82%(14/17)和89%(32/36).21例TDR中,MSCT显示膈肌中断、缺损横断面12处(9例),采用MPR重组方法除显示上述12处外,还进一步显示8处(6例),共20处(15例),差异无统计学意义(P=0.125).MSCT横断面显示"颈圈征"6例,MPR方法显示14例,二者差异有统计学意义(P=0.021).MSCT横断面上观察膈肌中断缺损诊断TDR的敏感度、特异度分别为43%(9/21)和80%(12/15),MPR分别为71%(15/21)和93%(14/15),差异均无统计学意义(P值分别为0.125和0.500).MSCT横断面上观察"颈圈征"诊断TDR的敏感度、特异度分别为29%(6/21)和100%(15/15),MPR分别为67%(14/21)和100%(15/15),敏感度差异有统计学意义(P=0.021),特异度差异无统计学意义(P=1.000).结论 MSCT诊断TDR具有良好的敏感度、特异度和准确度;MPR是横断面诊断TDR的重要补充,有助于提高TDR诊断水平.     

创伤性膈肌破裂的诊断与治疗

目的 探讨创伤性膈肌破裂的早期诊断和治疗.方法 回顾性分析我科17年间收治的161例创伤性膈肌破裂患者的临床资料,包括诊断方法、术前确诊率、膈疝发生率、手术治疗方式和患者结局等.结果 161例中男139例,女22例;年龄9～84岁,平均32.4岁.ISS 13～66分,平均27.8;65.2%入院时有休克.钝性伤36例、穿透伤125例.术前膈肌损伤确诊率在钝性和穿透伤分别为88.9%和78.4%.膈疝发生率在钝性和穿透伤分别为94.4%和14.4%(P＜0.01).手术经胸30例,经腹106例,分别剖胸和剖腹18例、胸腹联合切口7例.病死率10.6%,ISS平均41.6;主要死因为失血性休克和严重感染并发症.钝性和穿透伤病死率分别为22.2%和7.2%(P＜0.01).结论 膈伤诊断依据,钝性伤主要为膈疝的影像学表现,穿透伤伤口远处腹或胸部也有阳性体征或影像学征象.膈疝手术的关键是准确判断疝入胃肠的活力.穿透伤预后相对较好.     

Helical CT of blunt diaphragmatic rupture

OBJECTIVE: This study evaluated CT findings for signs of blunt diaphragmatic rupture. MATERIALS AND METHODS: CT examinations of 179 blunt trauma patients, including 11 with left-sided and five with right-sided blunt diaphragmatic rupture, were reviewed by two staff radiologists who first decided by consensus on the presence or absence of 11 published signs of blunt diaphragmatic rupture and then formulated the diagnosis in terms of absence of, presence of, or suggestion of blunt diaphragmatic rupture. The significance of the findings was assessed by multivariate logistic regression. Four other reviewers interpreted the CT findings independently. They were asked first to formulate a diagnosis in terms of absence of, presence of, or suggestion of blunt diaphragmatic rupture and then to enumerate the findings supporting a diagnosis or suggestion of blunt diaphragmatic rupture. These findings were compared with those of the staff radiologists. RESULTS: Diaphragmatic discontinuity, diaphragmatic thickening, segmental nonrecognition of the diaphragm, intrathoracic herniation of abdominal viscera, elevation of the diaphragm, and both hemothorax and hemoperitoneum were strong predictors of blunt diaphragmatic rupture (p < 0.001). The combination of the first three findings was 100% sensitive (16/16). The staff radiologists' sensitivity for diagnosing blunt diaphragmatic rupture was 100% (16/16). The four reviewers' sensitivities were 56.2% (9/16), 81.2% (13/16), 62.5% (10/16), and 87.5% (14/16). CONCLUSION: Six of 11 signs were good predictors of blunt diaphragmatic rupture. Despite diaphragmatic thickening, focal defect and segmental nonrecognition had 100% cumulative sensitivity; the reviewers formulating the diagnosis before analyzing CT signs overlooked blunt diaphragmatic rupture on CT in 12.5-43.8% of the patients.     

Traumatic intrapericardial diaphragmatic hernia

Traumatic diaphragmatic hernia is an uncommon sequela of blunt abdominal injury. This report details the radiographic findings of a traumatic diaphragmatic hernia in which the diagnosis was missed at initial exploratory laparotomy and on multiple portable chest radiographs. At reoperation, the stomach was found within the pericardial sac.     

CT"内脏依靠征"对创伤性横膈破裂的诊断价值

目的：描述CT“内脏依靠征“,评价该征在腹部钝性外伤后横膈破裂的诊断价值。材料和方法：对10例经手术证实的外伤性膈疝病人的CT检查资料进行回顾性分析,评价“内脏依靠征“的诊断价值。结晶：依据“内脏依靠征“,CT明确诊断横膈破裂右侧3例,左侧6例,1例右侧破裂漏诊,总诊断准确率90％。结论：“内脏依靠征“很好地显示了横膈破裂的特征,有助于提高CT对腹部钝性外伤后横膈破裂的诊断准确率。     

The "dependent viscera" sign in CT diagnosis of blunt traumatic diaphragmatic rupture

OBJECTIVE: The objective of our study was to describe the "dependent viscera" sign and determine its usefulness at CT in the diagnosis of diaphragmatic rupture after blunt abdominal trauma. MATERIALS AND METHODS: The study sample consisted of 28 consecutive patients (19 men, nine women) between 17 and 74 years old (mean age, 31 years) who had undergone abdominal CT and subsequent emergency laparotomy after a blunt trauma. Ten patients had a diaphragmatic rupture (six, right-sided; four, left-sided) at laparotomy. An experienced radiologist unaware of the surgical findings retrospectively reviewed the CT scans, and then a second radiologist reviewed the scans to provide interobserver agreement. Note was made of discontinuity of the diaphragm, intrathoracic herniation of abdominal contents, and waistlike constriction of bowel (the collar sign). Also noted was whether the upper one third of the liver abutted the posterior right ribs or whether the bowel or stomach lay in contact with the posterior left ribs. Either of these findings was termed the "dependent viscera" sign. The radiologists' detection rate of diaphragmatic rupture on the CT scans via observance of the dependent viscera sign was determined. Interobserver agreement was assessed using Cohen's kappa statistic. RESULTS: The dependent viscera sign was observed on the CT scans of 100% of the patients with a left-sided diaphragmatic rupture and of 83% of the patients with right-sided diaphragmatic rupture. Both observers missed one case of right-sided diaphragmatic rupture. The radiologists' overall rate of detecting diaphragmatic rupture was 90% using the dependent viscera sign. We found excellent interobserver agreement (kappa = 1) for detection of the dependent viscera sign and for the diagnosis of diaphragmatic tear on CT scans. CONCLUSION: The dependent viscera sign increases the detection at CT of acute diaphragmatic rupture after blunt trauma.