Early diagnosis and surgical treatment of acute traumatic diaphragmatic rupture
-
摘要: 目的 总结创伤性膈肌破裂(traumatic diaphragmatic rupture,TDR)的诊治经验,提高早期诊断和救治能力。 方法 回顾性分析2001年4月—2013年11月淮北市人民医院收治的21例TDR的患者临床资料,男性18例,女性3例,左侧17例,右侧4例,开放性损伤13例,闭合性损伤8例,12例锐器伤,5例车祸伤,2例医源性损伤,2例高处坠落伤,10例合并休克,合并血气胸20例,心包破裂5例,心室破裂2例,上腔静脉损伤1例,肺裂伤8例,胃破裂4例,肝破裂4例,脾破裂2例,结肠破裂2例,重度颅脑损伤3例,脊柱骨折4例,截瘫2例,形成膈疝12例。其中16例行胸部CT检查,均手术治疗,单纯经胸手术7例,单纯经腹切口6例,腹部切口附加胸部切口3例,胸腹联合切口2例,胸腔镜手术3例。膈肌裂口均采取粗丝线直接缝合。对其致伤原因、诊断方法、急诊处理及手术方式进行分析。 结果 TDR多合并胸腹脏器损伤,临床表现复杂,螺旋CT检查具有较高的诊断价值,术前明确诊断13例(确诊率61.90%),术中探查确诊8例,其中电视胸腔镜探查手术均成功,手术治疗治愈18例,死亡3例。 结论 提高认识、急诊螺旋CT检查是早期诊断的主要手段,积极抗休克和及早手术治疗是救治成功的关键,电视胸腔镜手术是诊断和治疗TDR最具潜力的方法。Abstract: Objective To summarize the clinical experiences of early diagnosis and treatment of traumatic diaphragmatic rupture(TDR). Methods The clinical data of 21 cases(18 males and 3 females) with traumatic diaphragmatic rupture in our hospital from April 2001 to November 2013 were retrospectively reviewed.These were composed of 13 cases with closed injury and 8 cases with opend injury.They were injured with sharp instrument injury(12 cases),injury caused by traffic accident(5 cases),iatrogenic injury(2 cases) and injury by fall(2 cases).Left-sided TDR was found in 17 patients,right in 4.Among all patients,complicating with diaphragmatic hemias(12 cases),traumatic shock(10 cases),hemopneumothorax(20 cases),pericardium rupture(5 cases),ventricle rupture(2 cases),injury of superior vena cava(1 case),laceration of lung(8 cases),gastric rupture(4 cases),hepatic rupture(4 cases),rupture of spleen(2 cases),rupture colonale(2 cases),serious craniocerebral injury(3 cases),spinal fracture(4 cases) and paraplegia(2 cases) were surgical treated.Computerized topography was performed preoperatively in 16 cases.All patients received operation,and selected laparotomy in 6 cases,thoracototomy incision in 7 cases,thoracolapara incision in 2 cases,video-assisted thoracoscopic surgery in 3 cases.The causes,diagnosis,emergency treatment and operation method are analyzed. Results TDR usually combined with chest visceral injury,and was complexity in clinical manifestation.Thirteen patients were definitely diagnosed before the surgery(positive rate 61.90%),and 8 patients including video-assisted thoracoscopic surgery in 3 cases were diagnosed definitely during the surgery.Eighteen patients were cured and 3 patients were died. Conclusion Raise awareness and emergency chest CT examination were major means of early diagnosis.The early diagnosis and actively surgical treatment in time of complicated injuries is the key to cure the traumatic diaphragmatic rupture.Video-assisted thoracoscopic surgery is the highest potential approach to manage TDR.
-
Key words:
- Diaphragmatic rupture /
- Traumatic /
- Diagnosis /
- Therapy
点击查看大图
计量
- 文章访问数: 93
- HTML全文浏览量: 25
- PDF下载量: 1
- 被引次数: 0