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目的:探讨西宁地区(2260m)创伤性膈疝的病因、早期诊断、鉴别诊断与治疗的方法。方法:对15例创伤性膈疝患者临床资料进行分析,全部病人行手术治疗。结果:左侧13例,右侧2例;术前确诊12例,误诊3例(其中1例为慢性膈疝),均行膈肌修补术;12例经胸切口,2例经腹切口,1例经胸腹联合切口。14例治愈出院,1例死亡。结论:术前详细体检,结合胸部X线片及钡餐检查多能早期确诊;诊断困难者可结合CT、MRI等检查并与手术中仔细探查膈肌。由于高原缺氧,创伤性膈疝对机体影响大,一旦确诊即应急诊手术。
Objective: To explore the etiology, early diagnosis, differential diagnosis and treatment of traumatic diaphragmatic hernia in Xining area (2260m). Methods: Clinical data of 15 patients with traumatic diaphragmatic hernia were analyzed. All the patients underwent surgical treatment. Results: There were 13 cases on the left side and 2 cases on the right side. 12 cases were diagnosed preoperatively and 3 cases were misdiagnosed (1 case was chronic diaphragmatic hernia). All cases underwent diaphragmatic repair. 12 cases underwent transthoracic incision, 2 cases underwent abdominal incision and 1 case The thoracoabdominal incision. Fourteen patients were cured and 1 patient died. Conclusion: The preoperative detailed physical examination, combined with chest X-ray and barium meal can be diagnosed early; difficult diagnosis can be combined with CT, MRI and other tests and careful exploration of the diaphragm during surgery. Due to plateau hypoxia, traumatic diaphragmatic hernia has a great impact on the body, once diagnosed emergency surgery.