Chen J C, Wilson S E
Department of Surgery, Harbor-UCLA Medical Center, Torrance 90509.
Am Surg. 1991 Dec;57(12):810-5.
Between 1979 and 1989, 62 patients were treated for traumatic injury of the diaphragm. Forty-five had penetrating injuries following stab wounds or gunshot wounds, and 17 had diaphragmatic tears from motor-vehicle and auto-pedestrian accidents. Forty-one patients sustained left-sided injuries; 20 patients sustained right sided injuries; and one patient sustained bilateral ruptures. All patients underwent exploratory laparotomy and diagnosis was confirmed at surgery. Diaphragmatic injury was suspected in only 17 (27%) patients preoperatively. The chest radiograph showed nonspecific abnormalities in 48 (77%) patients and was diagnostic in 15 (24%) patients. Six patients had diagnostic peritoneal lavage; five were positive and one was negative. Computerized tomography (CT) of the lower thorax and abdomen was performed on 11 (18%) patients, but not one scan was diagnostic. Fluoroscopy in two patients was helpful. All patients had other associated injuries. The liver, spleen, or stomach were frequently injured in association with penetrating diaphragmatic lacerations. Bony fractures, splenic injuries, and head trauma were more commonly found with blunt diaphragmatic ruptures. The average hospital stay for the penetrating injuries was 11 days and for blunt trauma was 16 days. The operative mortalities was 2 per cent for penetrating injuries and 12 per cent for blunt injuries.
1979年至1989年间，62例患者接受了膈肌创伤治疗。45例因刺伤或枪伤导致穿透伤，17例因机动车和汽车行人事故导致膈肌撕裂。41例患者为左侧损伤；20例患者为右侧损伤；1例患者为双侧破裂。所有患者均接受了剖腹探查术，手术确诊。术前仅17例（27%）患者怀疑有膈肌损伤。胸部X线片显示48例（77%）患者有非特异性异常，15例（24%）患者可确诊。6例患者进行了诊断性腹腔灌洗；5例阳性，1例阴性。11例（18%）患者进行了下胸部和腹部的计算机断层扫描（CT），但无一例扫描可确诊。2例患者的荧光镜检查有帮助。所有患者均有其他合并伤。穿透性膈肌裂伤常合并肝、脾或胃损伤。钝性膈肌破裂更常见合并骨折、脾损伤和头部外伤。穿透伤患者的平均住院时间为11天，钝性伤患者为16天。穿透伤的手术死亡率为2%，钝性伤为12%。
