Williams R S
Med J Aust. 1982 Mar 6;1(5):208-11. doi: 10.5694/j.1326-5377.1982.tb132271.x.
This paper reviews 58 patients with traumatic rupture of the diaphragm treated at the Royal Adelaide Hospital during an 11-year period. The series appears to be the largest reported from one centre. The majority of cases resulted from blunt trauma to the trunk caused by motor vehicle accidents. More than half these patients sustained multiple injuries. A smaller group of patients had penetrating injuries to the diaphragm from gunshot or stab wounds. Clinical diagnosis of the ruptured diaphragm was seldom possible; an erect X-ray film of the chest was the best clue to diagnosis. In the acute phase, the injury was approached through laparotomy because of the need to exclude or treat other intra-abdominal injuries. Where diagnosis or treatment were delayed, thoracotomy was the approach of choice. Careful postoperative management, particularly of associated chest injuries, was the key to the low mortality achieved in this series.
本文回顾了皇家阿德莱德医院在11年期间收治的58例创伤性膈肌破裂患者。该系列似乎是来自一个中心报告的最大规模病例。大多数病例是由机动车事故导致的躯干钝性创伤引起的。这些患者中超过一半有多处损伤。一小部分患者因枪伤或刺伤导致膈肌穿透伤。很少能临床诊断出膈肌破裂；胸部立位X线片是诊断的最佳线索。在急性期，由于需要排除或治疗其他腹部损伤，通过剖腹手术处理损伤。当诊断或治疗延迟时，开胸手术是首选方法。术后仔细管理，尤其是对相关胸部损伤的管理，是该系列取得低死亡率的关键。
