妊娠晚期合并膈疝一例并文献复习  

Diaphragmatic hernia with pregnancy: a case report and literature review

作　　者：潘有光[1] 王进峰[1] 陈岗东[1] 王戈菲[1] 吴兆红[1] 

机构地区：[1]广州医学院第三附属医院心胸外科,510150

出　　处：《中华产科急救电子杂志》2013年第1期39-42,共4页Chinese Journal of Obstetric Emergency（Electronic Edition）

摘　　要：目的研究妊娠合并膈疝的临床特征及治疗策略。方法回顾分析广州医学院第三附属医院收治的1例及文献报道的25例妊娠合并膈疝患者的临床表现、诊治方法及妊娠结局。结果 26例妊娠合并膈疝患者中,23例出现膈疝临床症状的时间为晚期妊娠阶段,3例在妊娠中期;25例行影像学检查并确诊,1例根据临床症状诊断。膈肌裂口位于右膈肌2例,位于左膈肌15例,4例位于膈肌中心腱。22例患者因及时诊断、采取有效的处理措施而母子平安,1例因术后毒血症抢救无效导致母亲死亡,1例因孕妇短时间内行2次膈疝修补术而导致胎死宫内,2例因就诊时间较晚或未能及时明确诊断延误治疗而导致母婴死亡。结论妊娠合并膈疝及时而准确的诊断和治疗需多学科合作,严密观察患者病情变化,可获得良好的妊娠结局。Objective To explore the clinical features and treatment strategies of diaphragmatic hernia in the pregnant women. Methods We retrospectivly studied the clinical manifestation, treatment method and the outcome of 1 pregnancy woman with diaphragmatic hernia in the Third Affiliated Hospital of Guangzhou Medical University and previous 25 literature reports. Results Among the 26 cases, 3 cases had clinical manifestation in the second trimester and 23 cases in the third trimester. Twenty-five cases diagnosed by imageological examination and 1 case diagnosed by clinical symptoms. For diaphragm rip position, diaphragmatocele was in right diaphragm in 2 cases, while in left diaphragm in 15 cases, and in central tendon of diaphragm in 4 cases. Twenty-two pregnancies and babies had good outcome, which attributed to timely diagnosis and effective treatment. One pregnancy died of toxemia after operation. After diaphragmatic hernia repair twice in a short time, one pregnancy happen fetal intrauterine death. Two pregnancies and fetal dead resulted from delaying diagnoses and treatment. Conclusions For good pregnancy outcome, multidiseiplinary cooperation, closed monitoring and treatment of diaphragmatic hernia were necessary for pregnancy with diaphragmatocele.

关 键 词：膈疝 妊娠结局 病例报告 

分 类 号：R655.6[医药卫生—外科学] R714.2[医药卫生—临床医学]