膈肌损伤的诊断与治疗(附33例报告)

总结３３例膈肌损伤的诊断与治疗经验，其中穿透性损伤１６例，闭合性损伤１７例。３２例（９７％）合并其它脏器伤。经胸手术６例，经腹手术２８例，其中１例为腹剖手术后又开胸。术前确诊２４例（７２％）。全组死亡４例，死亡率１２１％。病人主诉和体检所见常是合并伤的表现，而胸部Ｘ线检查是最可靠的诊断方法。术前对膈肌损伤的高度警惕和术中仔细检查膈肌是减少漏诊的关键。早期剖腹手术无论对左侧或右侧膈肌损伤均是一种较好的手术径路。

The Diagnosis and Treatment of Injury of the Diaphragm Report of 33 Cases

Objective:Studying some characteristics in diagnosis and treatment of injury of the diaphragm.Method:Summarized the diagnosis and treatment of 33 cases of injury of the diaphragm.Of the 33 cases,16 resulted from penetrating injuries and 17 due to closed injuries.97% of the patients had other associated injeries.Thoracotomy in 6 cases and laparotomy in 28,including one case requiring subsequent thoracotomy.Result:The diagnosis was established preoperatively in 24 cases(72.7%).The overall mortality rate was 12.1%(4/33).Conclusion:Patients' chief complaints and physical examination findings were usually the manifestations of the associated injuries.Chest X ray is the most reliable method for making a diagnosis.The key in reducing misdiagnosis is being alert to the possibility of diaphragm of injury before operation and careful inspection of the diaphragm at operation.Initial laparotomy was a better operative approach for exploring either right or left diaphragmatic injury or for surgical repair.