创伤性膈肌破裂的诊断和治疗

目的：提高创伤性膈肌破裂的早期诊断及救治水平。方法：回顾总结1995年1月～2001年12月26例创伤性膈肌破裂。男23例、女3例。闭合性损伤15例、开放性损伤11例。多发伤25例，合并其它脏器部位损伤56处。伴有休克17例、腹膜炎15例、气胸8例、呼吸衰竭2例。术前确诊17例，术中探查发现9例。确诊时间24h内21例、1周内3例、2周内1例、半年内1例。手术经胸切口12例、经腹切口11例、胸腹联合切口3例。手术行疝回纳、修补膈肌裂口，并处理其他合并损伤。结果：治愈22例(84．6％)、死亡4例(15．4％)。分别死于重型颅脑外伤、严重肝破裂失血性休克、延误诊断后结肠绞窄所致MOF、脑外伤机械通气3个月后严重感染。结论：提高认识、正确运用辅助检查，有助于早期诊断。及时复苏、及早手术，正确处理其他合并伤是提高治愈率的关键。

The Diagnosis and Treatment of Traumatic Diaphragm Rupture

Objective: To improve in early diagnosis and treatment to traumatic diaphragm rupture. Methods: 26 patients(23 males and 3 females) suffered from traumatic diaphragm rupture from 1995 to 2001 were summarized retrospectively, who were composed of 15 cases with closed injury and 11 cases with opened injury. Among them 25 patients suffered from polytrauma, complicating with injuries of other body sites(56 parts), traumatic shock(17 cases), acute peritonitis(15 cases), pneumothorax(8 cases) and respiratory failure(2 cases).17 patients were definitely diagnosed preoperatively and 9 patients by intraoperative exploration. Definite diagnosis was made within 24h posttrauma in 21 patients, 1week 3patients, 2weeks 1 patient and one half year 1 patient. All patients received operation after anti-shock and /or other treatments. The intra-abdoman, intra-thorax and intra-thoracolapara incisions were selected. Results:22 patients(84.6%) were cured. 4patients(15.4%) died of severe craniocerebral injury, severe liver rupture with haemorrhage shock, delayed diagnosis of colon strangulation with multiple organ failure and severe infection during mechanical ventilation, respectively. Conclusion: Increasing knowledge for traumatic diaphragm rupture and using correctly the auxiliary examinations might be helpful for early diagnosis. The key to improve ability of treatment is to resuscitate and operate in time and to manage the complicating injuries.