创伤性膈疝26例诊治分析

目的 总结创伤性膈疝的诊治经验。方法 回顾性分析26例创伤性膈疝临床资料,其中开放性损伤7例,闭合性损伤19例。92.3％(24/26)的病人合并其它脏器损伤。手术采用剖腹术16例,剖胸术6例,胸腹联合切口4例。结果 术前确诊19例(73.1％),治愈24例,死亡2例。结论 创伤性膈疝一经确诊应尽早手术治疗。胸部X线检查最具诊断价值。早期诊断、尽早手术修补膈肌裂口,及时、正确地处理合并脏器伤是提高治愈率的关键。     

创伤性膈疝早期诊断与治疗

目的 探讨创伤性膈疝的早期诊断和治疗。方法 分析38例创伤性膈疝患者受伤的原因,早期临床表现、主要检查资料及手术时机、死亡原因;钝性伤22例,锐器穿透伤16例;左膈疝32例,右膈疝6例;经腹手术23例,经胸手术15例。结果 32例(84.21%)术后痊愈,6例死亡,死亡率15.79%。结论 创伤性膈疝是胸腹部创伤患者较为隐秘、易漏诊的损伤之一,临床表现常被合并伤的表现所掩盖,应仔细询问受伤的原因,体位及外力作用的方向,全面认真的体检,及时、必要的影像学检查可提高早期诊断率,创伤性膈疝一经发现,应尽快给予手术治疗。     

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。     

36例创伤性隔疝治疗体会

目的:总结创伤性膈疝的救治经验。方法;自1990年～2003年共救治创伤性膈疝36例,其中右侧膈疝13例,左侧隔疝23例。术前确诊28例,术中探查发现8例。经胸手术23例,经腹手术9例,胸腹联合手术4例。结果:全组36例一次手术成功,无死亡。结论:创伤性膈疝的诊断,应结合病史,受伤部位、伤道以及临床表现做出综合判断,诊断一经明确就应及时进行手术修补,同时治疗合并损伤,是救治成功的关键。     

29例创伤性膈肌破裂或膈疝临床分析

目的 探讨创伤性膈肌破裂或膈疝的临床诊断特点和外科治疗方法.方法 回顾性分析南京明基医院2010年1月至2021年6月收治的29例胸腹部损伤合并膈肌破裂或膈疝的患者临床资料,对其致伤原因、临床特点、诊断手段和手术方法等进行总结.结果 12例先行胸部X线检查,其中9例提示创伤性膈肌破裂或膈疝可能.7例行胸部彩超检查,均提...     

创伤性膈疝21例诊治体会

目的 总结创伤性膈疝的临床特点，探讨诊断和治疗方法，以期提高诊治水平。方法 对21例创伤性膈疝患者受伤的原因、临床表现、各项检查的诊断价值和手术治疗的术式及结果进行回顾性分析。结果 术前确诊18例(85．7％)，漏诊3例(14、3％)，术后痊愈19例(90、4％)，死亡2例，病死率9．5％。结论 创伤性膈疝以左侧多发，往往以胸痛、腹痛、气促、呼吸困难为主要症状，常合并有其他脏器损伤，容易漏诊。钡餐动态X线胸腹联透，最具诊断价值．手术径路主视胸腹合并伤情况选择．     

骨盆骨折合并创伤性膈疝的临床特点及漏诊原因分析

[目的]总结骨盆骨折合并创伤性膈疝的临床特点并分析漏诊原因。[方法]回顾性分析2001年12月~2012年3月收治的836例骨盆骨折患者,其中7例合并创伤性膈疝。全部为男性。年龄19~63岁,平均40.5岁。交通伤3例,高处坠落伤2例,挤压伤1例,砸伤1例。骨盆骨折按Tile分型:B1型1例,B2型6例。膈疝全部为左侧。合并创伤性休克3例,合并肋骨骨折6例,合并脾破裂6例,合并胃肠道破裂2例,合并尿道断裂1例,合并其他部位骨折3例。2例骨盆骨折行骨盆外固定架固定,其余5例保守治疗。膈疝均行手术治疗。[结果]7例患者均于治愈或好转后出院。患者均获得随访,随访时间9~36个月,平均16个月。7例患者中4例创伤性膈疝漏诊。漏诊原因1例为膈疝症状不典型,3例为严重创伤掩盖膈疝症状。骨盆骨折均愈合,愈合时间3~6个月,根据Majeed功能评分,优4例,良2例,可1例,优良率85.7%。随访过程中未发现与创伤性膈疝相关的呼吸、消化、循环系统并发症。[结论](1)骨盆骨折合并创伤性膈疝多见于男性,多为高能量损伤所致,多合并肋骨骨折及脾破裂,其中骨盆骨折多为Tile B2型,膈疝多见于左侧;(2)骨盆骨折患者中创伤性膈疝的发生率虽低,但漏诊率较高,漏诊原因多为膈疝症状不典型或严重创伤掩盖膈疝症状;(3)骨盆骨折合并创伤性膈疝如能及时确诊,给予相应治疗,预后是良好的。     

严重多发伤合并创伤性膈疝32例诊治分析

创伤性膈疝常伴有严重的多发伤,临床上可因顾及到较明显严重的损伤而忽视了创伤性膈疝的存在,一旦漏诊,会造成严重后果[1]。我院于1999年1月至2004年1月收治严重多发伤合并创伤性膈疝患者32例,现就其早期诊断与治疗问题进行讨论。临床资料1.一般资料:本组32例患者,男26例,女6例;年龄11~64岁,平均35.6岁。受伤原因为车祸伤12例,坠落伤7例,刀伤10例,枪伤3例。入院距受伤时间30 min~8.5 h,其中29例在伤后2 h内入院。临床表现及诊断:患者均有胸腹痛、进行性呼吸困难。体检发现一侧肺部呼吸音低或消失,X线检查均发现一侧肺不张,胸腔有气液平面或…     

创伤性膈疝12例临床诊治体会

目的总结创伤性膈疝的诊治经验。方法对12例创伤性膈疝临床资料进行回顾性分析。结果术前确诊10例，治愈11例，死亡1例，病死率8．33％。结论创伤性膈疝一经确诊应尽早手术治疗。剖腹术是绝大多数创伤性膈疝患者首选的手术方法，尽早手术修补膈肌裂口，及时正确地处理合并脏器伤是提高治愈率，降低死亡率的关键。     

创伤性膈疝28例分析

目的探讨创伤性膈疝的临床特征和诊治。方法对28例创伤性膈疝患者的临床资料进行回顾分析。结果全组治愈25例,死亡3例,死亡率10．7％。结论胸腹部创伤患者应警惕膈肌的损伤,创伤性膈疝表现常被合并伤的表现所掩盖。早期诊断,及早手术,及时处理多发伤和并发症是提高治愈率、降低死亡率的关键。     

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％。     

Diaphragmatic hernia: an uncommon cause of dyspepsia.

Adult onset diaphragmatic hernia is a rare condition with variable clinical manifestations. The majority of adult-onset diaphragmatic hernia is associated with trauma. Blunt thoracic and abdominal trauma associated with a 5% to 7% incidence of diaphragmatic injury, and in 3% to 15% for those with penetrating injury. These injuries may be left unrecognized when they occur but often are uncovered months later during work up for related symptoms. Prompt diagnosis and surgical repair is recommended by most authorities. Traditionally, diaphragmatic hernia is repaired by laparotomy or thoracotomy, or both. Herein, we report a case of adult onset diaphragmatic hernia presented with dyspepsia that was successfully repaired via laparoscopy. Operative approach and technique of diaphragmatic defect closure is elucidated.     

Traumatic diaphragmatic hernia

Thirty-four patients with traumatic diaphragmatic hernia treated between 1941 and 1972 were reviewed. The patients were analyzed as to the mode of trauma, location of the diaphragmatic injury and associated injuries, and the time and methods of diagnosis. The mortality rate was 23%, and deaths were due primarily to the severity of associated injuries, especially in patients sustaining blunt trauma. The necessity of immediate laparotomy in patients with acute diaphragmatic hernia appears indicated by the high incidence of associated intraabdominal injuries that required surgical management. Thoracotomy was employed primarily in patients undergoing delayed repair and was rarely necessary for control of acute associated intrathoracic injuries.     

An undiagnosed left sided traumatic diaphragmatic hernia presenting as small intestinal strangulation: A case report

INTRODUCTIONPost traumatic diaphragmatic hernia is very often missed particularly in polytrauma patients. We present case of an isolated post traumatic diaphragmatic hernia with strangulation, a very rare finding.PRESENTATION OF CASEA 35 year old man presented with features of intestinal obstruction with past history of a seemingly trivial blunt thoracic injury 15 years back. Findings of X-ray abdomen and chest with high leukocyte count raised suspicion of obstructed diaphragmatic hernia which on exploration revealed obstructed diaphragmatic hernia with gangrenous bowel segment.DISCUSSIONBlunt injury of diaphragm is relatively common and is considered as a marker of severe trauma and it can clinically be occult as other violent injuries may mask and disguise its initial clinical presentation¹ resulting in late presentation with obstruction and/or rarely strangulation. An early diagnosis of the condition is prudent to avoid morbidity and mortality associated with late presentations.CONCLUSIONIn a patient of intestinal obstruction with history of even trivial throraco- abdominal injury, diagnosis of diaphragmatic hernia should be kept in mind.     

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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。     

外伤性膈疝23例诊治体会

目的探讨外伤性膈疝的诊断和治疗方法。方法回顾性分析我院1994年1月~2005年6月间收治的外伤性膈疝23例的临床资料。结果本组术前诊断明确者14例,误诊9例;治愈20例,死亡3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;胸腔穿刺抽出胃肠道内容物对于膈疝的诊断有很大的意义,但应在X线监控下进行,以免发生副损伤。外伤性膈疝一经确诊,应立即手术治疗。     

Right diaphragmatic iatrogenic hernia after laparoscopic fenestration of a liver cyst: report of a case and review of the literature

Iatrogenic right diaphragmatic hernia is very rare. We report the first case of a patient who had a diaphragmatic hernia after laparoscopic fenestration of liver cyst. A herniorrhaphy of the diaphragmatic defect was carried out after reducing the herniated organ. The postoperative course was uneventful. Diaphragmatic hernias are not as common as the traumatic type. Surgeons can easily miss diaphragmatic injuries during the operation especially after laparoscopy. Late diagnosis of iatrogenic diaphragmatic hernias is frequent. Ct scan is helpful for diagnosis. Surgery is the treatment of diaphragmatic hernia at the time of diagnosis, even with asymptomatic patients. The incidence of iatrogenic diaphragmatic hernia after surgery may be reduced if the surgeon checks for the integrity of the diaphragm before the end of the operation. A review of the literature is also performed regarding this rare complication.