创伤性膈疝的诊断与治疗

目的 总结创伤性膈疝的诊断和治疗经验。方法 分析27例创伤性膈疝患者受伤的原因，入院时的主要症状，体征，合并伤，信要检查资料及手术时机，死亡原因，钝性伤13例。锐器穿透伤14例；左膈疝25例，右膈疝2例；经腹手术14例，经腹手术13例。结果 22例（81.5%)术后痊愈，5例死亡。死亡率18.5%。结论 胸腹部创伤患者应警惕膈肌的损伤，创伤性膈疝的表现常被合并伤的表现所掩盖，要注意受伤的原因，体位及外力作用的方向。认真的胸部X线电视透视是最可靠的检查方法。创伤性膈疝一经发现，应尽快给予手术治疗。

Diagnosis and treatment of traumatic diaphragmatic hernia

Objective To report the clinical diagnosis and treatment of traumatic diaphragmatic hernia (TDH). Methods An analysis was done on injury causes, major symptoms, physical signs, associated injury, examination data, operation time and death causes of 27 cases of TDH. Of 27 cases, there were 25 cases of left-diaphragmatic hernia, 2 right diaphragmatic hernia, 13 closed injury and 14 penetrating injury. Thoracotomy was performed in 13 cases and laparotomy in 14. Results Twenty-two cases (81.5%) survived after operation but 5 died with a mortality rate of 18.5%. Conclusions We must be alert to the possible diaphragmatic injury in the patients with thoracic injuries. TDH is easily neglected because of complications in the chest and the abdomen. Attention should be paid to injury cause, posture and direction of the outside force. Chest X-ray is the most reliable method for a diagnosis. The corresponding operation should be done as soon as possible.