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目的总结膈肌破裂和创伤性膈疝的临床表现及诊断治疗方法。方法对15例创伤性膈疝(左侧13例,右侧2例)患者的发病原因、合并伤、临床表现、诊断及治疗情况进行回顾性分析。结果本组15例均有2处以上合并损伤,其中多发肋骨骨折及血气胸9例,肺裂伤2例,胃破裂1例,骨盆骨折3例。第12胸椎椎体骨折伴截瘫1例,肝破裂2例,脾破裂1例,颅脑外伤2例,失血性休克5例。本组病例伤后确诊时间为24 h以内7例,24~72 h 7例,7 d 1例。12例术前已明确诊断,其中1例曾被误诊为张力性气胸,直到胸腔引流管引出食物残渣才得以诊断。3例在手术探查中发现。本组15例均经手术治疗后痊愈。结论单纯创伤性膈疝较少见,多有较严重的合并伤,表现缺乏特异性,易被伴发的胸腹部脏器损伤所掩盖,从而造成误诊或漏诊。详细了解受伤原因、部位及作用力方向,是早期诊断的关键。通过全面细致的体格检查、X线检查结合胸部CT、胃肠钡餐透视、B超等,可明确诊断。早期治疗应以抢救生命为重要原则,按照先重后轻的原则首先处理致命伤。膈疝一经确诊,无论裂口大小,均应及时手术。
Objective To summarize the clinical manifestations and diagnosis and treatment of diaphragmatic rupture and traumatic diaphragmatic hernia. Methods Retrospective analysis was made on the etiological factor, combined injury, clinical manifestations, diagnosis and treatment of 15 cases of traumatic diaphragmatic hernia (left and right sides in 2 cases). Results The group of 15 patients had more than 2 combined injuries, including multiple rib fractures and blood pneumothorax in 9 cases, 2 cases of lung laceration, gastric rupture in 1 case, pelvic fracture in 3 cases. The twelfth thoracic vertebral fractures with paraplegia in 1 case, 2 cases of liver rupture, 1 case of splenic rupture, 2 cases of traumatic brain injury, hemorrhagic shock in 5 cases. The diagnosis of this group of patients after injury within 24 hours in 7 cases, 24 to 72 h in 7 cases, 7 d in 1 case. Twelve cases had been diagnosed preoperatively, of which 1 had been misdiagnosed as tonic pneumothorax until the chest drain led to food debris. 3 cases found in surgical exploration. The group of 15 patients were cured after surgery. Conclusions Simple traumatic diaphragmatic hernia is rare, with more serious combined injury, the performance of the lack of specificity, easily accompanied by abdominal and abdominal organs damage covered, resulting in misdiagnosis or missed diagnosis. A detailed understanding of the cause of injury, location and direction of force is the key to early diagnosis. Through a comprehensive and detailed physical examination, X-ray examination combined with chest CT, gastrointestinal barium meal fluoroscopy, B-ultrasound, can confirm the diagnosis. Early treatment should be to save lives as an important principle, in accordance with the principle of first and foremost to deal with fatal injuries first. Diaphragmatic hernia once diagnosed, regardless of the size of the gap, should be timely surgery.