33例创伤性膈疝的诊断与治疗分析

目的总结分析33例创伤性膈疝患者的诊断及治疗经验。方法回顾分析2005年1月至2010年12月收治的33例创伤性膈疝患者病历资料,探讨诊断方法、手术原则及切口选择。结果 33例患者中,术前通过病史、体征、辅助检查确诊有25例（75.8%）,高度怀疑术中探查确诊的8例（24.2%）,其中在转入15例中院外误诊、漏诊10例（66.7%）。入院后均在72 h内明确诊断及手术,手术径路选择腹部切口19例（57.6%）,胸部切口10（30.3%）,采用胸腹联合切口4例（12.1%）。结论创伤性膈疝临床表现缺乏特异性,大多合并多部位严重损伤或休克,故容易误诊漏诊。因此,早期正确诊断是其治疗的关键,手术是其唯一的确定性治疗方法。

Diagnosis and treatment of traumatic diaphragmatic hemia in 33 patients

Objective To summarize the diagnosis and treatment of traumatic diaphragmatic hemia in 33 Patients.Methods Retrospectively analyzed the clinical data of 33 cases of traumatic diaphragmatic hemia,and the diagnosis methods,surgical principles and incision selection were discussed.Results Among the 33 patients,including 10 cases（66.7%）misdiagnosed by other hospital from the 15 transferred cases,25 cases（75.8%） were confirmed through medical history,signs,laboratory examinations before operation,8 highly suspected cases（24.2%） were confirmed through operation.And all the cases were diagnosed and operated within 72 hours.Of all the surgical approaches,there were abdominal incision 19 cases（57.6%）,chest incision 10 cases（30.3%）,thoracoabdominal incision 4 cases（12.1%）.Conclusion Because of the lack of clinical specificity and the combination of serious multi-location injury or shock,traumatic diaphragmatic hernia is often misdiagnosed.As a result,early diagnosis is the key to the treatment and surgery is the only deterministic treatment of traumatic diaphragmatic hernia.