Smithers B M, O'Loughlin B, Strong R W
Department of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Aust N Z J Surg. 1991 Oct;61(10):737-41.
Between 1975 and 1990, 85 patients with diaphragmatic rupture following blunt trauma were treated at the Royal Brisbane and Princess Alexandra Hospitals, Brisbane. There were 65 on the left, 17 on the right and three were bilateral. Road trauma was the cause in 88% of cases. In the first 48 h the diagnosis was made by chest X-ray in 51 patients, laparotomy in 22, autopsy in two, emergency room thoracotomy, ultrasound and pneumoperitoneum each in a single patient. Seven patients (8%) had delay in diagnosis greater than 48 h ranging from 6 days to 6 months. Diagnosis was subsequently made by pneumoperitoneum (3), chest X-ray (1) and exploratory thoracotomy (1). Two patients presented with a strangulated diaphragmatic hernia 3 and 6 months following an acute admission with blunt chest trauma and urological trauma respectively. During the study period a further five patients presented with an obstructing diaphragmatic hernia. Sixteen patients died (19%), fifteen from associated injuries and one related to the diaphragmatic repair. Ruptured diaphragm should be suspected in patients with severe chest trauma, particularly those requiring positive pressure ventilation, patients with intra-abdominal injuries and those with pelvic fractures. Early recognition and repair results in low morbidity and mortality. Measures that confirmed the diagnosis in patients with delay included repeated chest X-rays and pneumoperitoneum.
1975年至1990年间，布里斯班皇家布里斯班医院和亚历山德拉公主医院收治了85例钝性创伤后膈肌破裂患者。其中左侧65例，右侧17例，双侧3例。88%的病例由道路创伤引起。在最初的48小时内，51例患者通过胸部X线诊断，22例通过剖腹手术诊断，2例通过尸检诊断，1例通过急诊室开胸手术、1例通过超声、1例通过气腹诊断。7例患者（8%）诊断延迟超过48小时，范围从6天至6个月。随后通过气腹（3例）、胸部X线（1例）和探查性开胸手术（1例）确诊。2例患者分别在急性钝性胸部创伤和泌尿外科创伤入院后3个月和6个月出现绞窄性膈疝。在研究期间，另有5例患者出现梗阻性膈疝。16例患者死亡（19%），15例死于相关损伤，1例与膈肌修复有关。对于严重胸部创伤患者，尤其是需要正压通气的患者、腹部损伤患者和骨盆骨折患者，应怀疑有膈肌破裂。早期识别和修复可降低发病率和死亡率。对于诊断延迟的患者，确认诊断的措施包括重复胸部X线检查和气腹检查。
