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目的探讨外伤性膈肌破裂的诊断与治疗方法。方法本组13例外伤性膈肌破裂患者,男9例,女4例。年龄15~47岁,平均32岁。其中车祸伤造成膈肌破裂8例,高空坠落膈肌破裂2例,刀刺伤膈肌破裂3例。左侧膈肌破裂11例,右侧膈肌破裂2例。合并膈疝8例、血气胸7例、肋骨骨折5例、肝破裂2例、胃破裂3例、脾破裂2例、失血休克3例。本组病人全部进行剖胸探查手术,术前明确诊断6例,经手术探查确诊7例,术前确诊靠胸部CT、X线检查及胸腔穿刺等。手术行膈肌缝合修补以及合并脏器损伤的处理。结果本组病人无死亡。并发症2例,1例为ARDS,1例为胸腔感染,均治愈出院。结论对于外伤性膈肌破裂应早期诊断,及时地手术治疗是抢救成功的关键。
Objective To investigate the diagnosis and treatment of traumatic diaphragmatic rupture. Methods The group of 13 patients with traumatic diaphragmatic rupture, 9 males and 4 females. Aged 15 to 47 years old, average 32 years old. Among them, traffic accident caused 8 cases of diaphragmatic rupture, 2 cases of diaphragmatic rupture at high altitude and 3 cases of rupture of diaphragm caused by knife puncture. Left diaphragm rupture in 11 cases, right diaphragm rupture in 2 cases. 8 cases of diaphragmatic hernia, 7 cases of blood pneumothorax, rib fracture in 5 cases, 2 cases of liver rupture, 3 cases of gastric rupture, 2 cases of rupture of the spleen, and 3 cases of hemorrhagic shock. All patients underwent thoracotomy exploration operation, 6 cases were diagnosed preoperatively, 7 cases were diagnosed by operation exploration, and chest CT, X-ray examination and thoracentesis were performed before operation. Surgery, diaphragm suture repair and treatment of organ damage. Results of this group of patients without death. Complication in 2 cases, 1 case of ARDS, 1 case of chest infection were cured and discharged. Conclusion The diagnosis of traumatic diaphragmatic rupture should be diagnosed early and timely surgical treatment is the key to successful rescue.