钝性与穿透性膈肌损伤临床比较研究

膈肌损伤约占创伤的5%～7%,由于腹部钝性暴力使腹内压瞬间急剧升高,下胸肋骨对膈肌的机械作用,以及穿透伤时锐器的直接损伤导致膈肌破裂,分为钝性与穿透性膈肌损伤.其早期诊断面临巨大挑战,而且其并发症和病死率高.手术前难以做准确诊断,成功处理有赖于对临床高度可疑者进行仔细的胸部X线、CT检查和尽早的手术探查.由于膈肌损伤机制不同,各有其临床特点和处理上的特殊性,本文就穿透性和钝性膈肌损伤的临床处理研究进展做一比较讨论,以期进一步提高膈肌损伤的救治水平.

Comparative study on blunt and penetrating diaphragmatic injury

Diaphraghmatic injuries are rare(5%-7%),usually secondary to penetrating or blunt trauma to the abdomen or chest.According to the injury mechanism,the traumatic diaphragm rupture was distinguished as blunt and penetrating diaphragmatic injury.Early diagnosis continues to be a challenge and this type of injury is associated with high morbidity and mortality.Preoperative diagnosis is difficult and a high level of suspicion,careful scrutiny of the chest X-ray,and early surgical intervention are required for successful management.The purpose of this paper is to review the different experiences between blunt and penetrating diaphragmatic injury in the management of this injury.