Hromádka P, Cernohorský S, Baader M, Skach J, Gaalová R
Chirurgické Oddeleni, Krajská Nemocnice Liberec.
Rozhl Chir. 2010 Oct;89(10):638-41.
The diaphragm is the main respiratory muscle. It has the most significant function in respiratory excursions and the ability to maintain the negative thoracic pressure. Diaphragm injuries are relatively rare and they are the result of blunt or, in our conditions less often, penetrating thoracoabdominal trauma. (The ratio of blunt traumas to penetrating ones is 9:1). The diaphragmatic injuries in blunt injuries occur as a result of the increased pressure gradient between the pleural and peritoneal cavity [1]. The first description of traumatic diaphragm rupture is ascribed to Sennertus from 1541. Other sources award the primacy to the French royal surgeon A. Pare in 1579 [2]. It is similar to the primacy of the surgical repair of diaphragmatic injuries. Rioffi in 1886 [3] versus Naumann in 1888 who operated on traumatic herniation of the stomach into the left chest cavity [2]. Diaphragmatic injury diagnosis is difficult even today [4]; up to 10-50% of cases are not recognized in time. Left-sided traumatic lesion of the diaphragm occurs in 80-90% of cases. Our paper focuses on the specifics of right-sided diaphragm ruptures where the protective ability of the liver is probably reflected.
膈肌是主要的呼吸肌。它在呼吸运动中具有最重要的功能，并有维持胸内负压的能力。膈肌损伤相对少见，多由钝性伤引起，在我们的病例中穿透性胸腹联合伤较少见（钝性伤与穿透性伤的比例为9:1）。钝性伤导致的膈肌损伤是由于胸膜腔和腹膜腔之间压力梯度增加所致[1]。创伤性膈肌破裂的首次描述可追溯到1541年的森纳图斯。其他资料则认为1579年法国皇家外科医生A.帕雷首次描述了该病[2]。这与膈肌损伤手术修复的首次描述情况类似。1886年的里奥菲[3]与1888年对胃外伤性疝入左胸腔进行手术的瑙曼[2]。即使在今天，膈肌损伤的诊断也很困难[4]；高达10%-50%的病例未能及时确诊。80%-90%的病例为左侧膈肌创伤性病变。我们的论文重点关注右侧膈肌破裂的特点，其中可能体现了肝脏的保护作用。
