Department of Cardiothoracic Surgery, Hunan Children's Hospital, No. 86 Ziyuan Road, Changsha, 410007, Hunan, China.
Department of Cardiothoracic Surgery, First People's Hospital of Chenzhou, Chenzhou, 423000, Hunan, China.
BMC Surg. 2021 Mar 19;21(1):142. doi: 10.1186/s12893-021-01141-2.
We present here our experience with surgical management of traumatic diaphragmatic hernia, trying to find out the era impact of different periods on the outcome and risk factors of mortality.
A series of 63 patients with traumatic diaphragmatic hernia were referred to us and operated on during March, 1990-August, 2017. The patient records were reviewed and statistically analyzed to demonstrate injury characteristics and to find out optimal treatment strategy, risk factors of death as well as the difference between two periods (1990-2005, 2005-2017) divided by introduction of computed tomography at our institution.
The overall mean age was 31.2 ± 16.3 years old with a female to male ratio of 11/52. The mechanism was penetrating trauma in 19 cases (30.2%), and blunt trauma in 44 cases (69.9%). Two thirds of the patients in the second group (2005-2017) yet none in the first group (1990-2005) underwent computed tomography. Ten patients (15.9%), of which 8 in the first and the other 2 in the second group (p = .042), had late diagnoses. The most commonly used incision was a thoracotomy (n = 43, 89.6%). There was no statistical difference in etiology or mortality between the two periods. Univariate analysis showed survivors were younger, and had lesser injury severity scores (ISS) and lower American Association for the Surgery of Trauma (AAST) grade than non-survivors. By multivariate logistic regression analysis, increased age (odds ratio, 1.275; p = .013) and greater ISS (OR, 1.174; p = .028) were risk factors of death in all patients.
High-definition computed tomography has significantly improved the preoperative diagnosis rate. The transthoracic approach could be used in selected cases with traumatic diaphragmatic hernia with good outcomes. Patients with greater ISS and advanced ages are at a higher risk of death.
我们在此介绍外伤性膈疝的外科治疗经验，试图找出不同时期对外科治疗结果和死亡率的影响。
1990 年 3 月至 2017 年 8 月，我们收治了 63 例外伤性膈疝患者并进行了手术治疗。回顾患者病历并进行统计学分析，以展示损伤特征，找出最佳治疗策略、死亡的危险因素以及通过我院计算机断层扫描（CT）的引入将两个时期（1990-2005 年和 2005-2017 年）进行区分的差异。
患者的平均年龄为 31.2±16.3 岁，男女比例为 11/52。19 例（30.2%）为穿透性损伤，44 例（69.9%）为钝性损伤。第二个时期（2005-2017 年）的 2/3 患者（2005-2017 年）和第一个时期（1990-2005 年）的无 1 例患者进行了 CT 检查。10 例患者（15.9%）出现了延迟诊断，其中 8 例发生在第一个时期，另 2 例发生在第二个时期（p=0.042）。最常使用的切口是开胸术（n=43，89.6%）。两个时期在病因或死亡率方面无统计学差异。单因素分析显示，存活组患者年龄较小，创伤严重程度评分（ISS）和美国创伤外科学会（AAST）分级较低。多因素 logistic 回归分析显示，年龄增加（优势比，1.275；p=0.013）和 ISS 增加（OR，1.174；p=0.028）是所有患者死亡的危险因素。
高分辨率 CT 显著提高了术前诊断率。对于外伤性膈疝，选择性经胸入路可获得良好的效果。ISS 较高和年龄较大的患者死亡风险更高。
