Division of Thoracic Surgery, McGill University, The Montreal General Hospital, Room L9-112, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada.
Thorac Surg Clin. 2009 Nov;19(4):485-9. doi: 10.1016/j.thorsurg.2009.07.008.
Acute diaphragmatic hernia is a result of diaphragmatic injury that accompanies severe blunt or penetrating thoracoabdominal trauma. It is frequently diagnosed early on the trauma bay chest radiograph or CT scan of the chest. However, in the absence of a hernia, it may be difficult to identify traumatic diaphragmatic injury on conventional imaging. A midline laparotomy is the advocated approach for repair of acute diaphragmatic trauma because it offers the possibility of diagnosing and repairing frequently associated intraabdominal injuries. In hemodynamically stable patients with penetrating left thoracoabdominal trauma, the incidence of injury to the diaphragm is very high, and thoracoscopy or laparoscopy is recommended for the diagnosis and repair of a missed diaphragmatic injury. Repair with nonabsorbable simple sutures is adequate in most cases, and the use of mesh should be reserved for chronic and large defects. Outcomes of acute diaphragmatic hernia repair are largely dictated by the severity of concomitant injuries, with the Injury Severity Score being the most widely recognized predictor of mortality.
急性横膈疝是由于严重的钝性或穿透性胸腹部创伤引起的横膈损伤所致。它通常在创伤区的胸部 X 光或胸部 CT 扫描中早期诊断。然而，在没有疝的情况下，在常规影像学上可能难以识别创伤性横膈损伤。中线剖腹手术是修复急性横膈创伤的推荐方法，因为它提供了诊断和修复经常伴随的腹腔内损伤的可能性。在血流动力学稳定的穿透性左胸腹部创伤患者中，膈损伤的发生率非常高，推荐使用胸腔镜或腹腔镜检查诊断和修复漏诊的膈损伤。在大多数情况下，使用不可吸收的简单缝线修复即可，而应将网片保留用于慢性和大的缺损。急性横膈疝修复的结果在很大程度上取决于伴随损伤的严重程度，损伤严重程度评分是死亡率最广泛认可的预测指标。
