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腹腔镜修复膈肌破裂:一例影像学与手术关联的病例报告

Laparoscopic Repair of Diaphragmatic Rupture: A Case Report with Radiological and Surgical Correlation.

作者信息

Nguyen Patrick, Davis Bonnie, Tran Daniel D

机构信息

Howard University College of Medicine, Washington, DC 20059, USA.

Department of Radiology, Howard University Hospital, Washington, DC 20060, USA.

出版信息

Case Rep Surg. 2017;2017:4159108. doi: 10.1155/2017/4159108. Epub 2017 Aug 20.

Abstract

The leading cause of diaphragmatic rupture is penetrating abdominal trauma, including gunshot- and stab-related wounds; however, diaphragmatic rupture can also result from blunt trauma to the abdomen. The diagnosis can be difficult to make as the physical examination may be unremarkable, and imaging, that is, a conventional chest X-ray and/or CT imaging, may initially fail to reveal the injury. Failure to recognize diaphragmatic rupture can result in a delayed presentation, sometimes years later, with a potential catastrophic outcome. Therefore, prompt and swift diagnosis is critical to avoid this potential harmful scenario. Traditionally, repair is performed through a laparotomy or a thoracotomy incision. Owing to the many advances made in minimally invasive surgery, not only has laparoscopy become the modality of choice to diagnose diaphragmatic rupture due to its high degree of sensitivity and specificity, but it can provide simultaneous therapeutic intervention as well. We report a case of laparoscopic repair of a diaphragmatic rupture in a 22-year-old female who sustained blunt abdominal trauma during a motor vehicle accident.

摘要

膈肌破裂的主要原因是穿透性腹部创伤,包括枪伤和刺伤;然而,腹部钝性创伤也可能导致膈肌破裂。由于体格检查可能无明显异常,且影像学检查(即传统胸部X线和/或CT成像)最初可能无法发现损伤,因此诊断可能很困难。未能识别膈肌破裂可能导致延迟就诊,有时数年之后才出现,可能会产生灾难性后果。因此,迅速准确的诊断对于避免这种潜在的有害情况至关重要。传统上,修复是通过剖腹手术或开胸手术切口进行的。由于微创手术取得了许多进展,腹腔镜检查不仅因其高度的敏感性和特异性而成为诊断膈肌破裂的首选方式,而且还可以同时进行治疗干预。我们报告了一例22岁女性膈肌破裂的腹腔镜修复病例,该女性在机动车事故中遭受了腹部钝性创伤。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/436d/5585677/14d0a32eaff4/CRIS2017-4159108.001.jpg

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