经腹修补创伤性膈疝及膈肌损伤16例报告  

Traumatic Diaphragmatic Hernia and Traumatic Diaphragmatic Injury Treated by Abdominal Operation ：16 Cases of Report

作　　者：张德巍[1] 唐元新[1] 董彪[1] 杨大业[1] 郑元[2] 

机构地区：[1]中国医科大学附属第四医院第三普外 [2]中国医科大学附属第四医院第二普外,辽宁沈阳110032

出　　处：《医学临床研究》2015年第11期2081-2084,共4页Journal of Clinical Research

基　　金：辽宁省自然科学基金（课题编号：2013021003）

摘　　要：【目的】探讨经腹手术治疗创伤性膈疝（TDH）及膈肌损伤（TDI）的手术指征及治疗结果。【方法】回顾性分析16例经腹手术治疗TDH及TDI患者的致伤原因、临床表现、术前检查、手术入路选择依据及手术治疗结果。【结果】本组16例，男14例，女2例，其中左侧13例，右侧1例，双侧2例，全组患者均伴有合并伤，其中合并创伤、失血性休克11例。x线检查8例，确诊5例；CT检查16例，确诊13例；胸腔镜检查2例，均可见膈肌损伤。16例均行经腹膈肌修补术，治愈15例，并发症3例，切口感染2例，炎性肠梗阻1例，死亡1例，死亡原因：多脏器功能衰竭。【结论】大多数TDH及TDI可通过腹部途径进行修补，术中既能及时发现和处理腹腔内损伤的脏器控制出血，又可探查双侧膈肌，有效防止误诊和漏诊的发生，为损伤的膈肌进行修补，同时经腹手术尚可减少开胸对呼吸、循环系统的影响，利于术后排痰、康复。[Objective]To discuss the surgical indications and the treatment results of traumatic diaphragmatic hernia（TDH） and traumatic diaphragmatic injury（TDI）treated by abdominal operation.[Methods]Retrospective analy- sis of 16 patients with treatment of TDH and TDI underwent abdominal surgery was conducted in terms of causes, clinical manifestation, preoperative examination, surgical approach selection and the result of surgical treatment. IRe- suits]Sixteen cases were included in the group： 14 males,2 females; 13 left,1 right,2 double;all cases combined with united injury, 11 cases combined with traumatic shock. 8 cases examined by X-ray, 5 diagnosed ;16 cases examined by computed tomography, 135 diagnosed ; 2 cases examined by thoracoseopy, both with diaphragm injury; 16 cases were treated by abdominal diaphragm repair, 15 cases cured,3 cases with complicatlons,2 cases with incision infection, 1 case with inflammatory intestinal obstruction and 1 case died of multiple organ failure.[Conclusion] Most of TDI and TDH could be repaired by abdominal operation so as to treat bleeding of the abdominal organs timely ,and the double side of diaphragm could be examined to avoid the misdiagnosis and missed diagnosis. Meanwhile the abdominal opera- tion could reduce the effect of respiratory and circulatory system caused by open chest operation , and will be benefit to postoperative discharge of phlegm and rehabilitation.

关 键 词：腹部/外科学 疝 横膈 创伤性/外科学 膈/损伤 

分 类 号：R565[医药卫生—呼吸系统]