Tserng Teo Li, Gatmaitan Maria Benita
Department of Surgery, Trauma and Acute Care Surgery Service, Tan Tock Seng Hospital, Singapore.
Trauma Case Rep. 2017 Aug 5;10:4-11. doi: 10.1016/j.tcr.2017.05.010. eCollection 2017 Aug.
Traditionally, laparotomy/thoracotomy is the standard approach for thoracoabdominal injuries. However, it has a non-therapeutic rate of 12-40% and 40% morbidity. Laparoscopy, as a diagnostic and therapeutic modality, has evolved to be integral to general and subspecialty surgeons in the management of patients. However, its use in the field of trauma surgery has been limited. We present a case of traumatic diaphragmatic injury from a low velocity penetrating wound successfully repaired through laparoscopic approach.
A 20 year old male, presented with a traumatic diaphragmatic injury secondary to a low velocity penetrating injury. A computed tomographic scan revealed a tear on the left diaphragm with the superior pole of the spleen and omentum eviscerating through. He subsequently underwent diagnostic laparoscopy and primary repair of the diaphragmatic injury. His recovery was uneventful and he was discharged on the third postoperative day.
A review of current literature and our case suggest that the use of laparoscopy for the management of penetrating thoracoabdominal injuries is continually evolving and has shown to be a promising approach compared to traditional laparotomy in carefully selected patients. Laparoscopic repair of penetrating traumatic diaphragmatic injuries is a safe and expedient option for hemodynamically stable patients.
传统上，剖腹术/开胸术是胸腹联合伤的标准治疗方法。然而，其非治疗率为12% - 40%，发病率为40%。腹腔镜检查作为一种诊断和治疗方式，已逐渐成为普通外科和专科外科医生治疗患者不可或缺的手段。然而，其在创伤外科领域的应用一直有限。我们报告一例通过腹腔镜手术成功修复的低速穿透伤所致创伤性膈肌损伤病例。
一名20岁男性，因低速穿透伤继发创伤性膈肌损伤就诊。计算机断层扫描显示左侧膈肌撕裂，脾上极和大网膜疝出。随后，他接受了诊断性腹腔镜检查和膈肌损伤的一期修复。他恢复顺利，术后第三天出院。
对当前文献的回顾以及我们的病例表明，腹腔镜检查在穿透性胸腹联合伤治疗中的应用正在不断发展，与传统剖腹术相比，在精心挑选的患者中已显示出是一种有前景的方法。对于血流动力学稳定的患者，腹腔镜修复穿透性创伤性膈肌损伤是一种安全且便捷的选择。
