摘要
目的总结迟发性膈肌破裂后产生膈疝的临床表现、诊断要点和手术治疗经验。方法回顾性分析2000年1月～2016年12月北京协和医院诊治的40例迟发性膈肌破裂患者临床资料。40例中，36例有明确外伤史，32例存在胸部或腹部症状，8例体检发现。所有患者均合并膈疝，其中左侧膈疝32例，右侧膈疝8例。全麻下行急诊手术1例，择期手术39例。经胸途径手术38例，经胸腹联合切口手术2例。4例（均为右侧膈疝）经胸修补困难，联合开腹修补。36例直接缝合修补膈肌破裂口，4例采用聚丙烯网修补。结果所有患者均痊愈出院。术后住院5～26天，中位时间11天。1例急诊手术患者术后并发肠梗阻，于术后19天急诊剖腹探查，行粘连条索切除松解后康复出院。结论迟发性膈肌破裂合并膈疝较为罕见，结合病史、症状，行胸腹部CT＋膈肌三维重建检查有助于诊断和鉴别诊断。确诊后尽早手术治疗。
Objective To investigate the diagnosis and surgical therapy of delayed diaphragmatic rupture. Methods Forty patients with traumatic diaphragmatic rupture with delayed presentation were collected in Peking Uniom Medical College Hospital from January 2000 to December 2016. In all 40 patients, 36 patients had traumatic past history, 32 patients had clini- cal manifestations when diagnosed. Left-sided diaphragmatic rupture was found in 32 patients and right in 8 patients. 1 patient received emergency surgery and 39 received selective surgery. 38 patients received transthoracic surgery and 2 patients received combined thoracic-abdominal surgery. 36 patients received direct diaphragm suture and 4 patients received patch repair. Re- suits All patients were recovered from the hospital. The median length of postoperative hospital stay was 11 days （range, 5-26 days）. 1 patient was found intestinal obstruction and received enterolysis 19 days after surgery. Conclusion Delayed traumat- ic diaphragmatic rupture is a rare but serious disease. Careful past history, physical examination and CT scan with reconstruc- tion of diaphragm are helpful in diagnosis and differential diagnosis. Surgical therapy after diagnosis is the best treatment.
作者
赵珞
韩志军
刘洪生
张志庸
李单青
Zhao Luo;Han Zhijun;Liu Hongsheng;Zhang Zhiyong;Li Shanqing(Department of Thoracic Surgery,Peking Union Medical College Hospital,CAMS ＆ PUMC,Beijing 100730,China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2018年第7期391-393,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
迟发性膈肌破裂
诊断
治疗
Delayed diaphragmatic rupture
Diagnosis
Therapy
