ABSTRACT
Objective To probe timely diagnosis and surgical intervention of traumatic diaphragmatic rupture(TDR). Methods The clinical data of 161 patients with TDR treated surgically in our department during the past 17 years were analyzed retrospectively in respects of diagnostic methods,accuracy of preoperative judgment of TDR,incidence of diaphragmatic hernia,surgical procedures and outcome,etc. Results There were 139 males and 22 females at a mean age of 32.4 years(9-84 years),with average ISS of 27.8 points(13-66 points).Of all patients,65.2%had shock at admission.For these 161 patients,36 suffered from blunt injuries and 125 from penetrating injuries.For diaphragmatic injury.preoperative diagnostic rate was 88.9%for blunt injuries and 78.4%for penetrating injuries (P＞0.01).The incidence of diaphragmatic hernia was 94.4%in blunt injuries and 14.4%in penetrating injuries(P＜0.05).In this series,thoracotomy was performed in 30 patients,laparotomy in 106,thoracotomy plus laparotomy in 18 and combined thoraco-laparotomy in 7,with overall fatality rate of 10.6%and a mean ISS of 41.6 points.The mortality rate was 22.2%in blunt injuries and 7.2%in penetrating injuries(P＜0.01).The main causes for death were hemorrhagic shock and septic complications; Conclusions Blunt diaphragmatic injury can be diagnosed by radiographic signs of diaphragmatic hernia.According to"offside sign",which implies a thoracic wound with positive physical or radiological signs in the abdomen or in the thorax,penetrating diaphragmatic injury can be recognized.To deal with diaphragmatic hernia,it is important to judge the vitality of viscera.Penetrating injury has a relatively good prognosis.
ABSTRACT
Objective To explore the characteristics of diagnosis and treatment of thoracoabdominal combined injuries (TCI). Methods A retrospective study was carried out in 92 cases of TCI treated surgically, among whom were 41 cases (44.57%) with penetrating injury caused by sharp instument and 51 (55.43%) with blunt injury. Traffic injury was commonly seen. The injuries due to different causes and their clinical signs as well as operative measures were analyzed. Results Of 92 cases, 42 (45.65%) had diaphragmatic ruptures preoperatively, 88 (95.65%) diaphragmatic rupture was found in the first operation and was repaired; 4 (4.35%) did not receive disgnosis due to neglect of the diaphragm in operation; and 13 (14.13%) died. Conclusions TCI is a special type of multiple trauma with severe and complicated injuries and a high mortality. The diagnosis should be based on the mechanism of trauma and volume of bleeding. In the meantime, special attention should be paid to avoiding the missed diagnosis of diaphragmatic injuries. The treatment principle is thoracic injury first and laparotomy second.