手术治疗创伤性膈疝32例临床探析.docVIP

手术治疗创伤性膈疝32例临床探析【摘要】 目的 探讨创伤性膈疝的诊断及外科治疗。方法 回顾性分析2005年1月至2009年1月收治创伤性膈疝32例患者临床资料。结果 右侧4例,左侧28例,膈肌破裂长度5~17 cm;疝入胸腔的脏器右侧多为肝脏和胃,左侧以胃、脾、结肠、空肠为多见,其次为小肠及大网膜。30例治愈,均在术后2周内痊愈出院,随访1~3年无复发;2例死亡,死于多脏器功能衰竭。结论 创伤性膈疝通过询问病史、体格检查、相关检查提高早期诊断水平,及时手术、选择修补方式,同时并积极处理其他合并伤以改善预后。 【关键词】创伤性膈疝;诊断;外科治疗 Clinical investigation of operation on 32 patients with traumatic diaphragmatic hernia YANG Wen-dong,ZHANG Wen-long,ZHONG Biao.Cardiothoracic Surgery Department,Central Peoples Hospital of Huizhou City,Huizhou 516001,China 【Abstract】 Objective To investigate the diagnosis of traumatic diaphragmatic hernia and surgical treatment.Methods Clinical data.of 32 patients with traumatic diaphragmatic herniatreated from January 2005 to January 2009 were retrospectively analysedt.Results The right side in 4 cases,left in 28 cases,diaphragmatic rupture length of 5~17 cm; hernia into the chest of the organs,mostly the right side of the liver and stomach,left to the stomach,spleen,colon,jejunum is more common,followed by small intestine and omentum.30 cases were cured and discharged after 2 weeks without recurrence during 1 to 3 years follow-up; 2 patients died of multiple organ failure.Conclusion By asking medical history,physical examination,the relevant checks can improve early diagnosis and timely surgery of the traumatic diaphragmatic hernia.We should choose the repair method at the same time and actively deal with other associated injuries in order to improve prognosis. 【Key words】 Traumatic diaphragmatic hernia; Diagnosis; Surgical treatment 膈疝指腹内脏器经膈肌的薄弱孔隙、缺损或创伤裂口进入胸腔所致,临床分为食管裂孔疝、先天性膈疝和创伤性膈疝三类。创伤性膈疝近年来由于损伤原因的增多,其发生率已跃居膈疝的首位[1],其损伤机制复杂,生理紊乱严重,症状相互影响[2],及时正确的诊断与处理是抢救成功的关键。本文回顾性分析我院创伤性膈疝患者的临床报告如下。 1 临床资料 1.1 一般资料 2005年1月至2009年1月收治创伤性膈疝32例,男22例,女10例;年龄14~62岁,中位年龄39.4岁。车祸伤20例,利器伤8例,高空坠落伤4例。临床表现:胸闷、气促、胸腹部疼痛,呼吸困难,同时伴有烦躁、发绀、频繁呕吐等症状。均在伤后8 h内急诊入院,22例合并有胸腹部多器官损伤,其中肝破裂6例,脾破裂12例;多发肋骨骨折16例,骨盆骨折2例,四肢骨折4例,腰椎骨折2例。 1.2 诊断情况 术前确诊23例,4例单行胸部X线片检查;19例行胸腹部CT检查或胸腹部X线片检查,见纵隔明显向健侧移位、膈肌模糊、膈肌抬高及完整性