膈的解剖学特点与创伤性膈破裂及膈疝的救治  

The diagnosis and treatment of traumatic diaphragmatic hernia and diaphragmatic rupture

作　　者：王立[1] 孔志莹 邓伟均[1] 张利华[1] 利盛成 雷小东[1] 

机构地区：[1]东莞市石龙人民医院外科,广东东莞523324 [2]龙南县人民医院外科,江西龙南341700

出　　处：《中国临床解剖学杂志》2004年第3期318-320,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的:探讨创伤性膈疝/创伤性膈破裂的诊断及治疗特点。方法:总结经手术证实的32例创伤性膈破裂与膈疝病例,其中开放性损伤18例(56.2%),以刀刺伤为主;闭合性损伤14例(43.8%),以交通伤多见。膈破裂18例,膈疝14例中有2例慢性(延迟期)膈疝。分析不同致伤原因造成的损伤类别,临床症状特点及手术方式。结果:术前确诊膈破裂与膈疝的13例(40.6%);31例(96.8%)在第一次手术中发现膈破裂与膈疝,予以修补;1例漏诊(3.2%);死亡3例(9.6%)。结论:⑴创伤性膈破裂与膈疝是一种特殊类型的损伤,伤情危重、复杂,死亡率高;⑵可根据受伤机制及胸腹腔出血量对诊断作判断;⑶正确选择手术入路与受损器官处理先后顺序能提高抢救成功率。Objective: To explore the points of diagnosis and treatment of t raumatic diaphragmatic hernia and diaphragmatic rupture. Methods: A retrospectiv e study was carried out in 32 cases of traumatic diaphragmatic hernia and diaphr agmatic rupture treated surgically. In 18 of 32 cases (56.2%) diaphragma suffere d penetrating injury by sharp instrument, in 14(43.8%) suffered blunt injury. 18 cases occurred diaphragmatic rupture, 14 cases presented diaphragmatic hernia a nd 2 cases had Chronic diaphragmatic hernia among them. The types of damage due to different causes, their clinical signs as well as operative measures were ana lyzed. Results: For 32 cases, 13(40.6%) had been diagnosed as diaphragmatic rupt ure or diaphragmatic hernia preoperatively, 31(96.8%) were found diaphragmatic r upture and diaphragmatic hernia in the first operation and were repaired, 1(3.2% ) missed diagnosis, and 3(9.6%) died. Conclusions: Traumatic diaphragmatic rupt ure and diaph ragmatic hernia is a special type of multiple trauma with severe i njury and high mortality. The diagnosis should be based on the mechanism of trau ma and volume of bleeding. To choose proper operative approach and optimize the steps of treatment is important to increase the success rate of emergency tre atment.

关 键 词：膈 胸部损伤 腹部损伤 创伤 膈疝/膈破裂 

分 类 号：R655.6[医药卫生—外科学]