Department of General Surgery, Inonu University School of Medicine, Turgut Ozal Medical Center, 44315, Malatya, Turkey.
Surg Today. 2011 Oct;41(10):1352-6. doi: 10.1007/s00595-010-4518-3. Epub 2011 Sep 16.
Traumatic diaphragmatic rupture (TDR) is associated with high rates of morbidity and mortality, and the preoperative diagnosis is difficult.
Forty-eight patients with TDR were treated in our department between January 2000 and May 2009. The cause, location, size of rupture, associated morbidity and mortality, surgical material for repair, and predictive factors for overall outcome were evaluated.
There were 41 male patients (85%) and 7 female patients (15%) with a mean age of 33.8 years (range 17-69 years). Blunt trauma accounted for the injuries of 15 patients (31%) and 33 patients (68%) had penetrating injuries. The diagnosis was preoperatively established in 12 patients (25%) with a plain chest X-ray or/and computed tomography. The location of rupture was on the left side of the diaphragm in 35 patients (73%), on the right side in 10 (21%), and was bilateral in 3 patients (6%). Traumatic diaphragmatic rupture was repaired with interrupted nonabsorbable sutures or polypropylene mesh (8 patients). Postoperative complications were observed in 18 patients (38%). Overall mortality was observed in 7 patients (15%). The mortality was associated with hemorrhagic shock (P = 0.002), a high injury severity score (P = 0.002), and having additional injuries (P = 0.015).
The outcome of the patients is associated with presence of hemorrhagic shock, a high injury severity score, and additional organ injury.
创伤性横膈破裂（TDR）与高发病率和死亡率相关，术前诊断困难。
2000 年 1 月至 2009 年 5 月，我们科室治疗了 48 例 TDR 患者。评估病因、破裂位置、大小、相关发病率和死亡率、修复用的外科材料以及整体预后的预测因素。
48 例患者中，男 41 例（85%），女 7 例（15%），平均年龄 33.8 岁（17-69 岁）。15 例（31%）为钝性损伤，33 例（68%）为穿透性损伤。12 例（25%）患者术前通过胸部 X 线或/和计算机断层扫描诊断，12 例（25%）患者术前通过胸部 X 线或/和计算机断层扫描诊断。破裂位置位于膈肌左侧 35 例（73%），右侧 10 例（21%），双侧 3 例（6%）。35 例（73%）采用间断不可吸收缝线或聚丙烯网片修补膈肌破裂，8 例（17%）采用间断不可吸收缝线或聚丙烯网片修补膈肌破裂。术后发生 18 例并发症（38%）。7 例（15%）患者死亡。死亡率与失血性休克（P=0.002）、高损伤严重程度评分（P=0.002）和其他器官损伤有关（P=0.015）。
患者的预后与存在失血性休克、高损伤严重程度评分和其他器官损伤有关。
