19例創(chuàng)傷性膈疝的外科診治分析

[摘要] 目的 探討創(chuàng)傷性膈疝的診斷及治療經(jīng)驗。 方法 回顧總結2001年1月～2012年8月筆者所在科室收治的19例創(chuàng)傷性膈疝患者的臨床病例資料。 結果 19例患者均采用手術治療，本組術前確診16例，術中探查確診1例，其他科轉(zhuǎn)入漏診、誤診2例，1例因復合傷（合并顱腦損傷出血、肝脾破裂、骨盆骨折）嚴重死于多器官衰竭，本組患者術前確診率為89.4%，誤診率為10.5%，治愈率為94.7%。 結論 創(chuàng)傷性膈疝常為復合傷，病因多為胸部銳器傷和鈍性傷，根據(jù)臨床癥狀、體征、胸部X線片、CT、上消化道造影等輔助檢查，提高對創(chuàng)傷性膈疝的警惕性，早期明確診斷，及時手術治療，是提高治愈率的關鍵 。

[關鍵詞] 創(chuàng)傷傷性膈疝；診斷；治療

[中圖分類號] R655.6 [文獻標識碼] B [文章編號] 2095-0616（2012）22-201-02

Analysis on 19 cases of surgical treatment for traumatic diaphragmatic hernia

WANG Jianguo WANG Guirong WANG Jundong CUI Yong LI Hong

Department of Cardiothoracic Surgery，Dali People's Hospital of Yunnan Province，Dali 671000，China

[Abstract] Objective To investigate the experience of diagnosis and treatment of traumatic diaphragmatic hernia. Methods Reviewed the clinical data of 19 cases with traumatic diaphragmatic hernia in our department from January 2001 to August 2012. Results 19 patients were treated by operation.16 cases were diagnosed before surgery，one cases was confirmed during surgical exploration，two cases that transferred from other divisions were missed diagnosis. One case died of multiple organ failure，due to injury （brain injury associated with hemorrhage，rupture of liver and spleen，severe pelvic fracture）. The preoperative diagnosis rate was 89.4%，the misdiagnosis rate was 10.5%，the cure rate was 94.7%. Conclusion Traumatic diaphragmatic hernia is often combined with injury，mostly by chest sharp injuries and blunt trauma.According to the clinical symptoms，signs，chest X-ray，CT upper gastrointestinal radiography and other auxiliary examination，improving vigilance of traumatic diaphragmatic hernia.It is the key to increase the cure rate that early definitive diagnosis and timely surgical treatment.

[Key words] Traumatic diaphragmatic hernia；Diagnosis；Treatment

創(chuàng)傷性膈疝臨床上較少見，臨床表現(xiàn)復雜，是一種嚴重創(chuàng)傷，因直接或間接創(chuàng)傷致膈肌破裂，腹腔內(nèi)臟器官進入胸腔所引起的疾病，常合并其他部位的嚴重損傷，缺乏特異性，很容易漏診、誤診[1]，延誤治療，據(jù)報道誤診率高達30%～60%[2]，早期診斷和積極手術治療是救治創(chuàng)傷性膈肌破裂的關鍵[3]，心胸外科2001年1月～2012年8月收治19例創(chuàng)傷性膈疝患者，現(xiàn)報道如下。

1 資料與方法

1.1 一般資料

本組19例患者，男16例，女3例；年齡16～62歲，平均（35.0±11.6）歲；車禍傷8例，高處墜落傷4例，擠壓傷2例，銳器貫通傷2例，鈍物砸傷3例；左側膈疝17例，右側膈疝2例；其中合并顱腦外傷4例，脾破裂2例，肝裂傷2例，胃腸裂傷3例，肺挫傷并血氣胸9例，骨盆骨折5例，四肢骨折4例，腰椎骨折2例，多發(fā)肋骨骨折10例。疝入胸腔的臟器為胃、大網(wǎng)膜、脾、橫結腸及部分肝葉。……