【摘要】 目的　探讨创伤性膈肌损伤的早期诊断及手术入路选择。方法　回顾性分析近 10年来收治的 2 3例创伤性膈肌损伤患者的临床资料。结果　术前诊断 12例 (5 2 .2 % ) ;术中确诊 8例(3 4.8% ) ;漏诊 3例 ,漏诊率为 13 .1%。全组患者均经手术治疗 ,经胸手术 12例 ,经腹手术 8例 ,胸腹联合切口手术 3例。术中见腹腔内脏器疝入胸腔 18例 ,单纯膈性肌损伤 5例。术后并发脓胸 2例。死亡 3例 ,死亡率 13 .1% ,死亡原因为失血性休克和多器官功能衰竭。结论　创伤性膈肌损伤早期诊断困难 ,关键是要考虑到膈肌损伤。创伤性膈肌损伤一经诊断或怀疑其可能时 ,应及早手术治疗。要根据受伤机制、受伤部位 ,选择手术入路 ,并根据术中发现选择手术方式。更多还原

【Abstract】 Objective To explore the early diagnosis and optimum operative approach of traumatic diaphragma rupture (TDR) . Methods The clinical dada of 23 patients with TDR admitted to our hospital in recent 10 years were retrospectively analyzed. Results The diagnosis of TDR was made before operation in 12 cases1 (52.2%), and intraoperation in 8 (34.8), and misdiagnosed in 3 cases (13.1%). All the 23 patients underwent operation. Of the 23 patients, the operation was performed via thorax approach in 12 patients , via abdominal approach in 8, and via thorax-abdominal approach in 3. Hernation of the abdominal viscera into the thorax was observed in 18 cases, and single TDR in 5 cases.Empyema occurred after operation in 2 patients. 3 cases(13.1%) dead of hypovolemic shock and multiple organs failure. Conclusions The diagnosis of TDR may be difficult. The key of the diagnosis of TDR is to think of it. Once the diagnosis is made or suspected, the operation should be taken as early as possible. The choice of operative approach should be according to the injury mechanism and location; the choice of the operative procedure should be according to the intraoperative findings.更多还原