摘要
目的探讨膈肌破裂的临床诊断特点和腹腔镜手术疗效。方法回顾性分析中山大学附属第六医院2022年1月至2024年9月收治的19例膈肌破裂后膈疝患者的临床资料。结果男7例,女12例,有明确外伤史9例,全部为闭合性损伤(车祸伤1例,钝性伤7例,高处坠落伤1例);医源性膈肌损伤导致膈肌破裂10例。左侧膈疝13例,右侧膈疝6例。合并食管裂孔疝5例。所有患者均行择期腹腔镜膈疝无张力修补术,术中缝合膈肌缺损并放置复合补片修补。术后出现复张性肺水肿转入ICU 1例,所有患者均痊愈出院,术后中位住院时间10 d。结论膈肌破裂多见于外伤及医源性损伤,早期诊断和积极的腹腔镜手术治疗效果确切。
Objective To evaluate the clinical diagnosis and laparoscopic surgical management of diaphragmatic rupture.Methods Clinical data of 19 patients diagnosed with diaphragmatic hernia secondary to diaphragmatic rupture,admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from Jan 2022 to Sep 2024 was retrospectively analyzed.Results There were 7 males and 12 females.Traumatic etiology was confirmed in 9 cases,all developed after closed injuries,including one vehicular accident,seven blunt traumas,and one fall from height.Iatrogenic factors accounted for the remaining 10 cases.Left-sided diaphragmatic hernias were observed in 13 patients,while right-sided hernias occurred in 6 patients.Hiatal hernias were complicated in 5 patients.All patients underwent elective laparoscopic tension-free repair using composite patch for defect closure.Postoperatively,one patient was readmitted into ICU due to reexpansion pulmonary edema but was subsequently discharged following recovery.The median postoperative hospital stay was 10 days.Conclusions The incidence of diaphragmatic rupture is relatively uncommon,primarily occurring as a result of traumatic or iatrogenic injuries.Early diagnosis coupled with prompt laparoscopic surgical intervention has proven to be effective in managing this condition.
作者
李祎娉
黄恩民
马宁
侯泽辉
陈双
周太成
Li Yiping;Huang Enmin;Ma Ning;Hou Zehui;Chen Shuang;Zhou Taicheng(Department of General Surgery(Department of Gastrointestinal and Hernia Surgery),the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China;Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China;Biomedical Innovation Center,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)
出处
《中华普通外科杂志》
北大核心
2025年第9期691-695,共5页
Chinese Journal of General Surgery
基金
国家临床重点专科,广东省消化系统疾病临床医学研究中心项目(2020B1111170004)。
关键词
疝修补术
疝
横膈
创伤性
腹腔镜膈疝修补术
Herniorrhaphy
Hernia,diaphragmatic,traumatic
Laparoscopic diaphragmatic hernia repair
