创伤性膈疝的诊治  

Diagnosis and treatment for wound diaphragm of hernia

作　　者：蔡吉祥[1] 林永德[1] 崔恒江[1] 

机构地区：[1]江苏省东台市人民医院胸外科,江苏东台224200

出　　处：《河北医学》2002年第10期876-878,共3页Hebei Medicine

摘　　要：目的 :总结创伤性膈疝的诊治体会 ,探讨对急性期创伤性膈疝的早期诊断和手术治疗的方法。方法 :本组创伤性膈疝 11例 ,膈肌损伤原因 :胸部闭合性损伤 9例 ,开放性损伤 2例。诊断根据胸腹部创伤史 ,创伤部位疼痛 ,呼吸困难 ,气管移位 ,伤侧呼吸音减弱或消失 ,伤侧下胸部闻及肠鸣音等症状体征 ,X线胸片在膈上见胃肠腔的典型影像 ,超声检查在膈上见肝脏脾脏的回声等 ,证实急性期病例 10例 ,慢性期 1例。手术治疗术前置胃管减压 ,根据创伤部位及合并伤选择合适的手术径路 ,还纳疝入胸腔的脏器 ,根据膈肌裂口状况选择不同缝合方法修补缝合膈肌裂口。结果 :11例手术痊愈 10例 ,1例因合并严重的肺挫伤 ,失血性休克 ,呼吸性衰竭死亡。结论 :对创伤性膈疝及早明确诊断是获得及时救治的关键。急性期创伤性膈疝可因严重的原发性创而掩盖膈疝的症状而延误诊断 ,应予以重视。Objective: To explore a method for wound diaphragm of hernia of impatient earlier period with surgical operation. Method:The reason of 11 examples diaphragm muscle hurt the reason: The chest shuts hurt9 examples, open hurt 2 examples; According to the chest and belly for shutting with opening the wound the history, wound part the ache, breathe with difficulty,pipe moving, harm the side the adman the noise to down or disappear, or smell and the crow of bowel, etc. X ray chest show the stomach and intestines on the diaphragm, Ultrasonic check on the diaphragm show the liver spleen the proof examine impatient period 10 examples, chronic period 1 example. The places the stomach to take care of the decompression before operation, according to the surgical operation path that the wound part and amalgamation harm the choice fit road, return the bring into the chest's dirty, adoption the variety the method to sew up the diaphragm muscle the open wound. Result: Surgical operations recover 10 example, 1 example the death because of the lung of serious amalgamation, lose the guts shock, adman exhaustion. Conclusion: To wound diaphragm the hernia; the clear and definite diagnosis acquire on time key. Impatient period wound diaphragm,the hernia can.because of the original hair wound of cover up the condition of illness of the diaphragm,the hernia seriously. but the delay examine a patient, should to pay attention.

关 键 词：创伤性膈疝 胸腹创伤 膈肌修补 诊断 治疗 

分 类 号：R655.6[医药卫生—外科学]