Murray J A, Demetriades D, Cornwell E E, Asensio J A, Velmahos G, Belzberg H, Berne T V
Department of Surgery, Los Angeles County-University of Southern California Medical Center, USA.
J Trauma. 1997 Oct;43(4):624-6. doi: 10.1097/00005373-199710000-00010.
The objective of this study was to (1) determine the incidence of diaphragmatic injuries in penetrating left thoracoabdominal trauma and (2) evaluate the role of laparoscopy in detecting clinically occult diaphragmatic injuries.
One hundred nineteen consecutive patients with penetrating injuries to the left thoracoabdominal region presenting to Los Angeles County-University of Southern California Medical Center were prospectively evaluated during an 8-month period. Either celiotomy (with hemodynamic instability or peritonitis) or laparoscopy was performed. Results of the clinical examination and roentgenographic findings were recorded preoperatively.
One hundred seven patients were fully evaluated. Fifty patients required emergent celiotomy. Fifty-seven patients underwent laparoscopy. The overall incidence of diaphragmatic injuries was 42% (59% for gunshot wounds, 32% for stab wounds). Among the 45 patients with diaphragmatic injuries, 31% had no abdominal tenderness, 40% had a normal chest roentgenogram, and 49% had an associated hemopneumothorax. Fifteen of the patients undergoing laparoscopy (26%) had occult diaphragm injuries.
(1) The incidence of diaphragmatic injuries in association with penetrating left thoracoabdominal trauma is high. (2) The clinical and roentgenographic findings are unreliable at detecting occult diaphragmatic injuries. (3) Laparoscopy is a vital tool for detecting occult diaphragmatic injuries among patients who have no other indications for formal celiotomy.
本研究的目的是（1）确定穿透性左胸腹外伤中膈肌损伤的发生率，以及（2）评估腹腔镜检查在检测临床隐匿性膈肌损伤中的作用。
在8个月的时间里，对连续119例因穿透性左胸腹外伤而就诊于洛杉矶县南加州大学医学中心的患者进行了前瞻性评估。根据情况进行剖腹手术（伴有血流动力学不稳定或腹膜炎）或腹腔镜检查。术前记录临床检查结果和X线检查结果。
107例患者得到了全面评估。50例患者需要紧急剖腹手术。57例患者接受了腹腔镜检查。膈肌损伤的总体发生率为42%（枪伤为59%，刺伤为32%）。在45例膈肌损伤患者中，31%无腹部压痛，40%胸部X线检查正常，49%伴有血气胸。接受腹腔镜检查的患者中有15例（26%）存在隐匿性膈肌损伤。
（1）穿透性左胸腹外伤合并膈肌损伤的发生率很高。（2）临床和X线检查结果在检测隐匿性膈肌损伤方面不可靠。（3）对于没有其他进行正规剖腹手术指征的患者，腹腔镜检查是检测隐匿性膈肌损伤的重要工具。
