Symbas P N, Vlasis S E, Hatcher C
Ann Thorac Surg. 1986 Aug;42(2):158-62. doi: 10.1016/s0003-4975(10)60510-3.
From 1970 to 1984, 189 patients with penetrating injury and 20 with blunt injury were treated at Grady Memorial Hospital. One hundred eight-five patients with penetrating injury (Group 1) and 9 with blunt injury (Group 2) required emergency laparotomy. In the remaining 15 patients (Group 3), the diagnosis of diaphragmatic injury was delayed from 18 hours to 15 years (mean, 8 months) after injury. The vast majority of the Group 1 and all Group 2 patients had injury to other organs, and the diagnosis of the diaphragmatic injury was made in almost all of them during the emergency laparotomy. The diagnosis in Group 3 patients was made by chest roentgenogram alone or with an upper gastrointestinal series or barium enema. All diaphragmatic injuries were repaired primarily except one which was repaired with Prolene mesh. Four of the Group 1 patients died, a mortality of 2.2%, and 2 of the Group 2 patients died, a mortality of 22.2%. All Group 3 patients recovered. This study suggests that diaphragmatic injury should be suspected in all patients with penetrating as well as blunt injury of the chest and abdomen and particularly of the epigastrium and lower chest. The presence of such an injury should be excluded before the termination of the exploratory procedure. Also, diaphragmatic injury should be suspected in patients with roentgenographic abnormalities of the diaphragm or lower lung field following trauma. The presence of diaphragmatic injury in such patients should be excluded with appropriate diagnostic studies to protect the patient from its late complications.
1970年至1984年期间，格雷迪纪念医院共收治了189例穿透伤患者和20例钝性伤患者。185例穿透伤患者（第1组）和9例钝性伤患者（第2组）需要进行急诊剖腹手术。其余15例患者（第3组）的膈肌损伤诊断在受伤后18小时至15年（平均8个月）被延迟。第1组的绝大多数患者和所有第2组患者都有其他器官损伤，几乎所有患者的膈肌损伤诊断都是在急诊剖腹手术期间做出的。第3组患者的诊断是通过单独的胸部X线检查或联合上消化道造影或钡剂灌肠做出的。除1例用普理灵补片修补外，所有膈肌损伤均进行了一期修补。第1组有4例患者死亡，死亡率为2.2%，第2组有2例患者死亡，死亡率为22.2%。第3组所有患者均康复。本研究表明，对于所有胸腹穿透伤和钝性伤患者，尤其是上腹部和下胸部损伤患者，均应怀疑有膈肌损伤。在探查手术结束前，应排除此类损伤的存在。此外，对于创伤后膈肌或下肺野有X线异常的患者，也应怀疑有膈肌损伤。应通过适当的诊断检查排除此类患者是否存在膈肌损伤，以防止患者出现晚期并发症。
