未经证实:创伤性膈肌损伤很少见,通常发生在胸腹外伤后。大多数患者会有其他可能危及生命的伤害。高怀疑指数是最重要的属性。不幸的是,它在高达33%的病例中被错误地诊断。如果不及时治疗,并发症的发生导致死亡率在25%至80%之间。
方法:我们报告一例29岁男性因道路交通事故导致胸腹外伤的急性膈肌撕裂。体格检查显示左半胸部没有正常的呼吸音。CT扫描证实左侧膈疝伴有网膜,胃,和横结肠内容物,所以建议手术干预。在腹腔镜检查期间,发现了一个长15厘米,宽5厘米的膈肌缺损。腹腔镜下疝气缩小,并用间断的不可吸收缝线修复缺损。作为一种加固,放置了内脏接触假体。患者恢复顺利,经过12个月的随访,他没有复发的证据。
未经证实:膈肌损伤不会自发闭合。建议采用腹部方法,因为它可以评估整个腹部并治疗任何相关损伤。使用不可吸收的缝合线进行水密闭合,并且在有大缺陷的情况下,建议在diaphragm肌的腹膜侧放置网片以加强初次修复。
结论:腹腔镜急诊手术已被证明对某些血流动力学稳定的患者是有效和安全的。患者可以期望微创手术的益处,如开放方法一样具有复发率。
UNASSIGNED: Traumatic diaphragmatic injuries are rare and usually occur after thoracoabdominal trauma. Most patients will have other potentially life-threatening injuries. High index of suspicion is the most important attribute. Unfortunately, it is incorrectly diagnosed in up to 33% of cases. If left untreated, the onset of complications carries mortality rates between 25 and 80%.
METHODS: We report a
case of an acute diaphragmatic laceration in a 29-year-old male with thoracoabdominal trauma due to a road traffic accident. Physical examination revealed an absence of normal breath sounds in the left hemithorax. CT-scan confirmed a voluminous left diaphragmatic hernia with omental, gastric, and transverse colon content, so surgical intervention was advised. During laparoscopy, a 15 cm long and 5 cm wide diaphragmatic defect was identified. The hernia was reduced laparoscopically, and the defect repaired with interrupted non-absorbable sutures. As a reinforcement, a visceral contact prosthesis was placed. The patient had an uneventful recovery and after 12-month follow-up he has no evidence of recurrence.
UNASSIGNED: Diaphragmatic injuries do not close spontaneously. An abdominal approach is recommended as it allows for evaluation of the entire abdomen and treatment of any associated injury. Watertight closure with nonabsorbable suture and in
case of large defects, the placement of a mesh on the peritoneal side of the diaphragm is recommended to reinforce the primary repair.
CONCLUSIONS: Laparoscopic emergency surgery has proved to be effective and safe in selected patients with hemodynamic stability. Patients can expect the benefits of minimal invasive surgery with recurrence rate like the open approach.