Ochsner M G, Rozycki G S, Lucente F, Wherry D C, Champion H R
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
J Trauma. 1993 May;34(5):704-9; discussion 709-10. doi: 10.1097/00005373-199305000-00013.
Diagnosis of diaphragmatic injury (DI) can be difficult in patients with penetrating trauma because physical examination, computed tomographic scan, chest x-ray films, and diagnostic peritoneal lavage may miss these injuries. Mandatory exploration has been recommended because of the increased mortality associated with missed DI. Thoracoscopy was prospectively evaluated as a less invasive method for diagnosing DI in patients with penetrating trauma. Over a 14-month period, 14 patients were evaluated by thoracoscopy; video thoracoscopy was used in the last 9. Findings of thoracoscopy were confirmed by laparotomy or laparoscopy. Thoracoscopy correctly identified the presence or absence of DI in nine and five patients, respectively (all patients). Video thoracoscopy was easier and faster to perform than non-video thoracoscopy. This is the first reported series in which video thoracoscopy has been used for trauma. We found this procedure to be safe, accurate, and less invasive than laparotomy for diagnosing DI.
对于穿透性创伤患者，膈肌损伤（DI）的诊断可能存在困难，因为体格检查、计算机断层扫描、胸部X光片以及诊断性腹腔灌洗都可能遗漏这些损伤。鉴于漏诊DI会增加死亡率，故建议进行强制性探查。胸腔镜检查作为一种侵入性较小的方法，被前瞻性地评估用于诊断穿透性创伤患者的DI。在14个月的时间里，对14例患者进行了胸腔镜检查；最后9例使用了电视胸腔镜。胸腔镜检查结果通过剖腹手术或腹腔镜检查得以证实。胸腔镜检查分别在9例和5例患者中正确识别了DI的存在与否（所有患者）。电视胸腔镜比非电视胸腔镜操作更简便、快捷。这是首次报道将电视胸腔镜用于创伤的系列研究。我们发现该方法在诊断DI时安全、准确，且比剖腹手术侵入性更小。
