腹腔镜检查在钝性创伤所致膈肌破裂治疗中的应用
Laparoscopy in the management of diaphragmatic rupture due to blunt trauma.
作者信息
Martin I, O'Rourke N, Gotley D, Smithers M
机构信息
Department of General Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
出版信息
Aust N Z J Surg. 1998 Aug;68(8):584-6. doi: 10.1111/j.1445-2197.1998.tb02105.x.
BACKGROUND
Traumatic diaphragmatic rupture remains a diagnostic challenge often unrecognized until laparotomy in over 40% of patients and the diagnosis is delayed in a further 15%. This report describes four patients diagnosed at laparoscopy with a ruptured diaphragm.
METHODS
One patient had a left diaphragmatic rupture amenable to laparoscopic repair in the emergency setting. Three patients underwent laparoscopy 2, 7 and 10 days after injury which revealed two right-sided and one extensive left-sided rupture, respectively; each required open repair.
RESULTS
While laparoscopy is an excellent diagnostic tool, particularly in the delayed setting, repair is not possible for right-sided ruptures because of the liver bulk.
CONCLUSIONS
Thoracoscopy in the instance of delayed presentation may offer the best chance for minimal-access diagnosis and treatment when there is suspicion of a right-sided diaphragmatic rupture.
背景
创伤性膈肌破裂仍是一个诊断难题，超过40%的患者在剖腹手术前常未被识别，另有15%的患者诊断延迟。本报告描述了4例经腹腔镜诊断为膈肌破裂的患者。
方法
1例患者左侧膈肌破裂，适合在急诊情况下进行腹腔镜修复。3例患者在受伤后2天、7天和10天接受了腹腔镜检查，分别发现2例右侧和1例广泛的左侧破裂；每例均需开放修复。
结果
虽然腹腔镜检查是一种出色的诊断工具，尤其是在延迟诊断的情况下，但由于肝脏体积较大，右侧破裂无法进行修复。
结论
对于延迟就诊且怀疑右侧膈肌破裂的情况，胸腔镜检查可能为微创诊断和治疗提供最佳机会。
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