警惕漏诊创伤性膈肌损伤中合并腹腔脏器损伤  

Awareness of Missed Diagnosis of Traumatic Diaphragmatic Injury Combined with Abdominal Organ Injury

作　　者：高翔 崔健 柯冀[1] 于涛[1] 于磊[1] GAO Xiang;CUI Jian;KE Ji;YU Tao;YU Lei(Department of Thoracic Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院胸外科,北京100730

出　　处：《临床误诊误治》2024年第3期17-20,共4页Clinical Misdiagnosis & Mistherapy

基　　金：北京市卫生健康委员会住院医师规范化培训质量提高项目(2023024)。

摘　　要：目的 总结创伤性膈肌损伤患者术前可能遗漏腹腔脏器损伤患者的临床特点和原因,探究此类患者行腹部探查的必要性。方法 回顾分析2013年9月—2023年8月胸外科急诊收治的术前漏诊腹腔脏器损伤的创伤性膈肌损伤患者13例的临床资料。结果 13例中男12例、女1例,平均年龄42.5岁。8例为穿透性损伤,5例为钝性损伤。患者因胸腔探查发现膈肌损伤,随后行腹腔探查,结果显示肝损伤4例,胃损伤4例,脾损伤3例,肠系膜损伤2例,小肠损伤1例,下腔静脉损伤1例,胰腺损伤1例。所有患者行膈肌修补术,腹腔脏器损伤行相应手术或保守治疗。所有患者均痊愈,无死亡患者。结论 当胸腔探查手术发现膈肌损伤时,即使术前腹部体征及影像学表现阴性也应积极行腹腔探查,以及时发现可能合并的腹腔脏器损伤,避免漏诊及误诊,改善患者预后。Objective To summarize the clinical characteristics and causes in patients with traumatic diaphragm injury who may have missed abdominal organ injury before surgery,and to explore the necessity of abdominal exploration in such patients.Methods The clinical data of 13 patients with traumatic diaphragm injury who had missed abdominal organ injury before surgery from September 2013 to August 2023 were retrospectively analyzed.Results Among the 13 patients,there were 12 males and 1 female,with an average age of 42.5 years.Eight patients had penetrating injuries and 5 patients had blunt injuries.Thoracic exploration revealed diaphragmatic injury,followed by abdominal exploration.The results showed liver injury in 4 patients,stomach injury in 4 patients,splenic injury in 3 patients,mesentery injury in 2 patients,small intestine injury in 1 patient,inferior vena cava injury in 1 patient,and pancreas injury in 1 patient.All patients underwent diaphragm repair and abdominal organ injury was treated with operation or conservative treatment.All patients recovered and no patients died.Conclusion When diaphragm injury is found in exploratory thoracic surgery,peritoneal exploration should be performed actively even if the preoperative abdominal signs and imaging findings are negative,so as to timely detect possible abdominal organ injury,to avoid missed diagnosis and misdiagnosis,and improve the prognosis of patients.

关 键 词：膈肌损伤 腹腔脏器损伤 漏诊 腹腔探查 胸腔探查 膈肌修补术 肝损伤 脾损伤 

分 类 号：R641[医药卫生—外科学]