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目的探讨创伤性膈疝的诊断与治疗,减少误诊漏诊率以及提高诊治率。方法对我院自1989年7月至2007年10月共手术治疗创伤性膈疝37例病人进行了回顾性分析。结果本组病人的临床表现复杂,大多数缺乏特征性征象。37例中20例术前明确诊断,确诊率70.3%。37例患者均经手术治疗,治愈36例,1例因合并伤严重,术后死于多脏器功能衰竭,病死率2.7%。结论创伤性膈疝多数为左侧,主要损伤机制是锐器伤和钝性伤。根据症状、体征,结合胸部X线、上消化道造影、CT等检查能提高诊断率。膈疝一经确诊,应及时手术治疗。根据胸、腹腔脏器损伤的情况,选择手术切口。早期诊断和及时正确的手术治疗是提高治愈率的关键。
Objective To investigate the diagnosis and treatment of traumatic diaphragmatic hernia, reduce the misdiagnosis and misdiagnosis rate and improve the diagnosis and treatment rate. Methods A total of 37 patients with traumatic diaphragmatic hernia treated in our hospital from July 1989 to October 2007 were retrospectively analyzed. Results The clinical manifestations of this group of patients are complex, most of the lack of characteristic signs. Twenty cases of 37 cases were diagnosed preoperatively with a confirmed rate of 70.3%. Thirty-seven patients were surgically treated, cured 36 cases, 1 case of severe combined injury, died of multiple organ failure after operation, mortality was 2.7%. Conclusions The majority of traumatic diaphragmatic hernia are on the left side. The main injury mechanisms are sharp wounds and blunt trauma. According to the symptoms, signs, combined with chest X-ray, upper gastrointestinal imaging, CT and other tests can improve the diagnostic rate. Diaphragmatic hernia once diagnosed, should be timely surgical treatment. According to the chest, abdominal organs injury, choose surgical incision. Early diagnosis and timely and correct surgical treatment is the key to improve the cure rate.