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目的:探讨闭合创伤性膈疝的诊断及治疗特点。方法:回顾总结自1983年3月-2003年8月,经手术证实的23例 闭合创伤性膈疝病例。1例膈疝在右侧,其它22例全部发生在左侧。其中车祸伤11例,钝器伤7例坠落伤2例,塌方挤压伤 1例,食管癌手术膈肌缝合不全1例和“自发性”膈疝1例。结果:术前确诊创伤性膈疝的15例(65.2％),6例(26％)在急诊手术 中发现;2例误诊(8.7％);死亡1例(4.3%)。结论:(1)闭合性膈疝往往有合并伤,提高早期诊断准确性,是救治病人的关键(2)选择 正确手术方式能提高抢救成功率,降低死亡率。(3)右侧闭合创伤性膈疝尽管发生率低,也不应忽视时其特点的把握,以免漏诊。
Objective: To investigate the diagnosis and treatment of closed traumatic diaphragmatic hernia. Methods: From March 1983 to August 2003, 23 cases of closed traumatic diaphragmatic hernia were retrospectively reviewed. One case had diaphragmatic hernia on the right side and the other 22 cases all occurred on the left side. Including car accident injury in 11 cases, blunt injury in 7 cases of falling injury in 2 cases, collapse crush injury in 1 case, esophageal cancer surgery in 1 case of diaphragm suture and “spontaneous ” diaphragmatic hernia in 1 case. Results: Fifteen patients (65.2%) were diagnosed with traumatic diaphragmatic hernia before surgery. Six patients (26%) were diagnosed during emergency operation. Two patients were misdiagnosed (8.7%) and one died (4.3%). Conclusion: (1) Closure diaphragmatic hernia often has combined injury, improve the accuracy of early diagnosis is the key to treatment of patients (2) choose the correct surgical approach can improve the success rate of rescue and reduce mortality. (3) the right side of the traumatic diaphragmatic hernia closure, although the incidence is low, it should not ignore the characteristics of the grasp, so as to avoid misdiagnosis.