Sanli Maruf, Işik Ahmet Feridun, Tunçözgür Bülent, Meteroğlu Fatih, Elbeyli Levent
Department of Thoracic Surgery, Gaziantep University Faculty of Medicine, Gaziantep, Turkey.
Ulus Travma Acil Cerrahi Derg. 2009 Jan;15(1):71-6.
We aimed to emphasize the importance of delay in diagnosis of traumatic diaphragmatic ruptures and to investigate the results of treatment methods.
The records of 13 patients (11 males, 2 females; mean age 34.6; range 7 to 52 years) with traumatic diaphragmatic ruptures were evaluated with respect to demographic data, type and time of trauma, symptoms, diagnostic methods, localization, surgical therapy, morbidity and mortality.
Blunt trauma was present in 8 cases (61.6%) and penetrating trauma in 5. Migration of abdominal organs into hemithorax was detected in 11 cases radiologically. The duration between diagnosis and the event was 2-20 years in 6 patients (46.1%). Three of them were penetrating and 3 were blunt trauma. In 3 cases, diagnosis had been overlooked despite exploratory thoracotomy and laparotomy in another center. Right hemi-diaphragm was injured in 1 patient and the left in 12 cases. Primary repair through posterolateral thoracotomy was performed in all cases. Morbidity occurred in 1 patient. No mortality was observed.
Diaphragmatic ruptures should be remembered in trauma cases because of the probability of their being missed, and ruptures should be explored during thoracotomy or laparotomy performed for other organ injuries. Delayed diagnosis will increase morbidity and mortality.
我们旨在强调创伤性膈肌破裂延迟诊断的重要性，并研究治疗方法的效果。
对13例创伤性膈肌破裂患者（11例男性，2例女性；平均年龄34.6岁；年龄范围7至52岁）的记录，从人口统计学数据、创伤类型和时间、症状、诊断方法、定位、手术治疗、发病率和死亡率等方面进行评估。
8例（61.6%）为钝性创伤，5例为穿透性创伤。11例经放射学检查发现腹部器官移入半胸。6例患者（46.1%）诊断与受伤事件之间的间隔为2至20年。其中3例为穿透性创伤，3例为钝性创伤。3例患者在另一中心尽管进行了开胸探查术和剖腹探查术，但诊断仍被遗漏。1例患者右侧半膈肌受伤，12例患者左侧受伤。所有病例均通过后外侧开胸进行一期修复。1例患者发生并发症。未观察到死亡病例。
由于创伤性膈肌破裂可能被漏诊，因此在创伤病例中应考虑到这种情况，并且在因其他器官损伤进行开胸术或剖腹探查术时应探查膈肌破裂。延迟诊断会增加发病率和死亡率。
