创伤性膈肌损伤的处理方法：单中心经验

Approach to Traumatic Diaphragm Injuries: Single Center Experience.

作者信息

Şentürk Mustafa, Çakır Murat, Ali Akbulut Muhammed, Yeşildağ Kerim

机构信息

Necmettin Erbakan University Meram Medicine Faculty Department of General Surgery Konya Turkey.

Konya Meram Education Research Hospital Department of Chest Disease Konya Turkey.

出版信息

J Acute Med. 2021 Mar 1;11(1):18-21. doi: 10.6705/j.jacme.202103_11(1).0003.

DOI:10.6705/j.jacme.202103_11(1).0003

PMID:33928012

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8075961/

Abstract

BACKGROUND

Traumatic diaphragm injuries are rare. After blunt trauma, injuries occur with a 1-7% rate. This rate increases up to 15% in penetrating injuries. Diagnosis may be diffi cult and imaging tests may be misleading. The misdiagnosis may lead to herniated abdominal organs towards the intrathoracic cavity, with a mortality rate between 30% and 60%. This study was designed to investigate the data of patients operated for diaphragmatic injury in our clinic.

METHODS

The files of trauma patients admitted to our hospital between 2014-2019 were reviewed retrospectively. The files of cases with diaphragmatic injury were examined. Patients were evaluated in terms of age, sex, type of injury, localization, additional organ injuries, grade, surgical method, and mortality. Values were statistically analyzed.

RESULTS

A total of 20 patients were included in the study. Of the patients, 7 were female and 13 were male. The mean age was 32.7 (17-52) years. Of the cases, 10 were with stab wounds while 4 were incar traffi c accidents and 6 were gunshot wounds. Although all patients had thoracoabdominal injuries, 4 patients had additional pelvic injuries. Of the cases, 14 were accompanied with lung injury while 5 with intestinal, 4 with the spleen, 3 with liver, and 2 with cardiovascular injury. Patients with intestinal resection performed had a longer hospitalization period than others. When the severity of the injury was evaluated, grade 3 injuries were detected most commonly, whereas 3 patients had grade 1, 2, and 4 injuries. Grade 5 injury was detected in 1 patient. Primary repair was performed in 18 patients and mesh repair was performed in 2 patients. In three cases, the repair was performed with a thoracic way. One patient died on the postoperative fi rst day.

CONCLUSIONS

Diaphragmatic injuries that may be missed during imaging may be damaged with many organs. Diaphragmatic injuries should be kept in mind in the upper abdominal and thoracic injuries.

摘要

背景

创伤性膈肌损伤较为罕见。钝性创伤后，损伤发生率为1% - 7%。穿透性损伤时，该发生率可增至15%。诊断可能困难，影像学检查可能产生误导。误诊可能导致腹腔脏器疝入胸腔，死亡率在30%至60%之间。本研究旨在调查我院因膈肌损伤接受手术治疗患者的数据。

方法

回顾性分析2014年至2019年我院收治的创伤患者病历。检查膈肌损伤病例的病历。从年龄、性别、损伤类型、部位、其他器官损伤情况、分级、手术方式及死亡率等方面对患者进行评估。对数据进行统计学分析。

结果

本研究共纳入20例患者。其中女性7例，男性13例。平均年龄为32.7岁（17 - 52岁）。病例中，10例为刺伤，4例为交通事故伤，6例为枪伤。尽管所有患者均有胸腹联合伤，但4例患者合并骨盆损伤。病例中，14例伴有肺损伤，5例伴有肠损伤，4例伴有脾损伤，3例伴有肝损伤，2例伴有心血管损伤。行肠切除的患者住院时间比其他患者长。评估损伤严重程度时，最常见的是3级损伤，而3例患者分别为1级、2级和4级损伤。1例患者为5级损伤。18例患者行一期修补，2例患者行补片修补。3例手术采用开胸方式。1例患者术后第一天死亡。