创伤性膈肌破裂的早期诊治  

Early Diagnosis and Treatment of Traumatic Diaphragmatic Rupture

作　　者：石勇[1] 阚奇伟[1] 刘泗军[1] 刘汉云[1] 催辉 胡祥[1] 郑磊[1] 

机构地区：[1]四川省眉山市人民医院,四川眉山620010

出　　处：《世界最新医学信息文摘》2015年第32期12-13,共2页World Latest Medicine Information Electronic Version

摘　　要：目的探讨创伤性膈肌破裂的早期诊断与治疗。方法回顾分析23例创伤性膈肌破裂的病例资料,分析不同诊断方式的术前诊断准确性,总结关于早期诊断及手术治疗的经验、教训。结果单纯胸片检查组的准确率57.1%,胸片+胸部CT检查组的准确率83.3%,单纯胸部CT检查组的准确率71.4%,诊断性穿刺阳性组的准确率100.0%。误诊1例,行膈肌修补22例,直接缝合修补19例,采用医用绦沦补片修补3例。胃穿孔修补5例,脾切除1例,植物人1例,无术中、术后死亡病例。术后随访无膈疝发生,膈神经损伤致膈肌麻痹1例。结论早期诊断创伤性膈肌破裂需结合临床资料及手术探查,手术治疗需注意全面监测、仔细探查及可靠修补。ABSTRACT：Objective discuss early diagnosis and treatment of traumatic diaphragmatic rupture（TDR）. Method review and analyze clinical data of 23 cases of TDR patients with diagnostic accuracy of different diagnostic methods and summarize experiences and lessons of early treatment. Result accuracy rate of chest X-ray group is 57.1%, chest X-ray＋chest CT group is 83.3%, chest CT group is 71.4%and diagnostic puncture positive group is 100.0%. And 1 case is misdiagnosed, 22 cases is applied diaphragmatic repair, 19 cases receives direct suture repair and other 3 cases receive repair with medical sash patch. 5 cases applies gastric perforation repair, 1 case is with splenectomy, 1 case vegetative state and no deaths during or after operation. There is no hernia by follow-up after operation, 1 case is diaphragmatic paralysis caused by phrenic nerve injury. Conclusion Early diagnosis of TDR requires combination of clinical data and surgical exploration, surgical treatment should pay attention to overall monitoring, careful exploration and reliable repair.

关 键 词：创伤 膈肌破裂 膈疝 

分 类 号：R264[医药卫生—中医外科学]