创伤性膈肌破裂67例临床分析

目的：探讨创伤性膈肌破裂（TDR）的临床特点。方法：回顾分析1998年7月～2009年10月我院收治的67例TDR病例资料。结果：TDR患者男51例,女16例;本组患者损伤严重度评分为（21.3±8.1）分;TDR左侧59例、右侧7例、双侧1例;65例伴有胸、腹腔脏器损伤,46例伴膈疝形成;60例术前有影像学检查结果。67例均行急诊手术治疗。CT对TDR诊断符合率为69.8%。TDR术前诊断率64.2%。62例治愈,无并发症发生,死亡5例。结论：对创伤性TDR患者,应重视TDR发生原因,早期诊断,适时掌握TDR的手术时机,正确选择处理顺序、手术入路和修补方式,能提高救治成功率和降低并发症发生率。

Diagnosis and therapy of traumatic diaphragmatic rupture

Objective：To investigate the diagnosis and therapy of traumatic diaphragmatic rupture （TDR）.Methods：67 patients with TDR were collected in our hospital from July 1998 to October 2009,and the retrospective analysis was performed.Injury severity score （ISS） was 21.3±8.1.Left side TDR was found in 59 patients（88.1%）,right side in 7 （11.7%） and bilateral in 1（0.2%）,65 complicated with thoracic-abdominal organs injury,46 diaphragmatic hernias.Imageology examination （thoracic-abdominal X-ray and computerized topography） was performed preoperatively in 60 cases.67 patients underwent emergency surgery.Results：In all patients,the incidence of TDR in male was more than that in female （P0.01）,left side more than right （P0.01）.The diagnostic accordance rate of computed tomography was 69.8% and preoperative diagnosis rate was 64.2%.Emergency operations were performed in 62 patients and no serious postoperative complications were observed.5 cases died.Conclusion：When the patients were found to have severe thoracic-abdominal injury,TDR should be considered.The early diagnosis depends on history,physical examination and imageology examination,and the aggregate analysis should be preformed.Selecting operative opportunity,processing sequence,approach and repair modes correctly could increase achievement rate of the therapy and decrease the incidence rate of complications in the patients with TDR.