Yücel Metin, Özpek Adnan, Tolan Hüseyin Kerem, Başak Fatih, Baş Gürhan, Ünal Ethem, Alimoğlu Orhan
Department of General Surgery, Ümraniye Training and Research Hospital, İstanbul-Turkey.
Ulus Travma Acil Cerrahi Derg. 2017 Mar;23(2):107-111. doi: 10.5505/tjtes.2016.91043.
Stab wounds in the left thoracoabdominal region may cause diaphragmatic injury. The aim of the present study was to determine incidence of diaphragmatic injury and role of diagnostic laparoscopy in detection of injury in patients with left thoracoabdominal stab wound.
Total of 81 patients (75 male, 6 female; mean age 27.5±9.8 years; range 14 to 60 years) who presented with left thoracoabdominal stab wound between April 2009 and September 2014 were evaluated. Laparotomy was performed on patients who had hemodynamic instability, signs of peritonitis, or organ evisceration. Remaining patients were followed conservatively. After 48 hours, diagnostic laparoscopy was performed on patients without laparotomy indication to examine the left diaphragm for injury. Follow-up and treatment findings were prospectively evaluated.
Thirteen patients underwent laparotomy while diagnostic laparoscopy was performed on remaining 68 patients. Left diaphragmatic injury was observed in 19 patients (23.5%) in the study group. Four injuries were diagnosed by laparotomy and 15 were diagnosed by laparoscopy. Presence of hemopneumothorax did not yield difference in incidence of diaphragmatic injury (p=0.131). No significant difference was detected in terms of diaphragmatic injury with respect to entry site of stab wound in the thoracoabdominal region (p=0.929).
It is important to evaluate the diaphragm in left thoracoabdominal stab injuries, and diagnostic laparoscopy is still the safest and most feasible method.
左胸腹区域的刺伤可能导致膈肌损伤。本研究的目的是确定膈肌损伤的发生率以及诊断性腹腔镜检查在检测左胸腹刺伤患者损伤中的作用。
对2009年4月至2014年9月期间出现左胸腹刺伤的81例患者（75例男性，6例女性；平均年龄27.5±9.8岁；范围14至60岁）进行评估。对有血流动力学不稳定、腹膜炎体征或脏器脱出的患者进行剖腹手术。其余患者进行保守治疗。48小时后，对无剖腹手术指征的患者进行诊断性腹腔镜检查，以检查左膈肌是否有损伤。对随访和治疗结果进行前瞻性评估。
13例患者接受了剖腹手术，其余68例患者进行了诊断性腹腔镜检查。研究组中有19例患者（23.5%）观察到左膈肌损伤。4例损伤通过剖腹手术诊断，15例通过腹腔镜检查诊断。血气胸的存在在膈肌损伤发生率方面没有差异（p=0.131）。在胸腹区域刺伤的进入部位方面，膈肌损伤没有检测到显著差异（p=0.929）。
评估左胸腹刺伤中的膈肌很重要，诊断性腹腔镜检查仍然是最安全、最可行的方法。
