Treatment and Diagnosis for Closed Loop Intestinal Obstruction asInitial First Presentation of Traumatic Diaphragmatic Hernia_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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严小贵 , 蒋新卫

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创伤性膈疝; 肠梗阻

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目的　总结以闭襻性肠梗阻为首发表现的膈疝的诊治经验。
方法　对我科收治的以闭襻性肠梗阻为首发表现的1例膈疝患者的临床资料进行回顾性分析，并结合文献进行总结。
结果　经全胸部X线平片、立位腹部X线平片及胸腹部CT明确诊断为闭襻性结肠梗阻、创伤性膈疝(疝内容物为横结肠)，急诊手术行嵌顿的疝内容物复位、膈肌修补及切除阑尾经阑尾残端行肠管减压术，术后患者恢复良好。
结论　仔细的病史采集和查体是明确诊断的基础，全胸部X线平片、立位腹部X线平片及胸腹部CT是明确诊断的重要方法，诊断明确后应及时手术，术中结肠梗阻可经阑尾残端行肠管减压。

Citation： 严小贵,蒋新卫. Treatment and Diagnosis for Closed Loop Intestinal Obstruction asInitial First Presentation of Traumatic Diaphragmatic Hernia. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(10): 1091-1092. doi: Copy

1.	吴阶平．黄家驷外科学　[M]．第6版．北京：人民卫生出版社， 2003: 1496-1497．.
2.	Díaz-Lara C, Sánchez-Pérez J, Sánchez-Marín A, et al. Incarcerated traumatic diaphragmatic hernia as an uncommon cause of acute abdomen [J]. Cir Esp, 2007; 81(1): 53-54.
3.	武有林, 严星荣. 创伤性膈肌破裂32例诊治体会 [J]. 中国普外基础与临床杂志, 2003; 10(1): 54-55.
4.	Ueno K, Murota Y, Takeda M, et al. Delayed traumatic diaphragmatic hernia with strangulated stomach： report of a case [J]. Kyobu Geka, 2008; 61(5): 423-426.
5.	杜巍, 周伟, 李伟阳, 等. 创伤性膈疝的诊断及手术治疗 [J]. 华中医学杂志, 2009; 33(3): 128-129.
6.	杨东奎，蔚巍. 膈疝的临床及影像学分析 [J]. 医学影像学杂志, 2009; 19(8): 981-983.
7.	Purdy MR. Large-bowel obstruction as a result of traumatic diaphragmatic hernia [J]. S Afr Med J, 2007; 97(3): 180-182.
8.	Trésallet C, Menegaux F, Izzillo R, et al. Usefulness of CT reconstructed pictures for diaphragmatic rupture after blunt trauma [J]. J Am Coll Surg, 2004; 198(4): 666-667.
9.	陈曌, 郭友, 郑晓林, 等. 外伤性膈疝的X线CT表现与临床对照 [J]. 罕少疾病杂志， 2008; 15（2）: 33-35.
10.	姚元章，张连阳，孙士锦，等．创伤性膈肌破裂的早期诊断及治疗 [J]．创伤外科杂志， 2007; 9(5)： 391-393．.
11.	Haciibrahimoglu G, Solak O, Olcmen A, et al. Management of traumatic diaphragmatic rupture [J]. Surg Today, 2004; 34(2): 111-114.
12.	Hani MB. A combined laparoscopic and endoscopic approach to acute gastric volvulus associated with traumatic diaphragmatic hernia [J]. Surg Laparosc Endosc Percutan Tech, 2008; 18(2): 151-154.
13.	王存川, 张松柏, 陈蓥, 等. 腹腔镜疝修补手术222例经验 [J]. 中国普外基础与临床杂志, 2005; 12(6): 551-553.
14.	魏维强, 柏本健, 解洪涛．电视胸腔镜在创伤性膈疝治疗中的应用 [J]．临床误诊误治, 2008; 21(6)： 69．.
15.	Ver MR, Rakhlin A, Baccay F, et al. Minimally invasive repair of traumatic right-sided diaphragmatic hernia with delayed diagnosis [J]. JSLS, 2007; 11(4): 481-486.

1. 　吴阶平．黄家驷外科学　[M]．第6版．北京：人民卫生出版社， 2003: 1496-1497．.
2. 　Díaz-Lara C, Sánchez-Pérez J, Sánchez-Marín A, et al. Incarcerated traumatic diaphragmatic hernia as an uncommon cause of acute abdomen [J]. Cir Esp, 2007; 81(1): 53-54.
3. 　武有林, 严星荣. 创伤性膈肌破裂32例诊治体会 [J]. 中国普外基础与临床杂志, 2003; 10(1): 54-55.
4. 　Ueno K, Murota Y, Takeda M, et al. Delayed traumatic diaphragmatic hernia with strangulated stomach： report of a case [J]. Kyobu Geka, 2008; 61(5): 423-426.
5. 　杜巍, 周伟, 李伟阳, 等. 创伤性膈疝的诊断及手术治疗 [J]. 华中医学杂志, 2009; 33(3): 128-129.
6. 　杨东奎，蔚巍. 膈疝的临床及影像学分析 [J]. 医学影像学杂志, 2009; 19(8): 981-983.
7. 　Purdy MR. Large-bowel obstruction as a result of traumatic diaphragmatic hernia [J]. S Afr Med J, 2007; 97(3): 180-182.
8. 　Trésallet C, Menegaux F, Izzillo R, et al. Usefulness of CT reconstructed pictures for diaphragmatic rupture after blunt trauma [J]. J Am Coll Surg, 2004; 198(4): 666-667.
9. 　陈曌, 郭友, 郑晓林, 等. 外伤性膈疝的X线CT表现与临床对照 [J]. 罕少疾病杂志， 2008; 15（2）: 33-35.
10. 　姚元章，张连阳，孙士锦，等．创伤性膈肌破裂的早期诊断及治疗 [J]．创伤外科杂志， 2007; 9(5)： 391-393．.
11. 　Haciibrahimoglu G, Solak O, Olcmen A, et al. Management of traumatic diaphragmatic rupture [J]. Surg Today, 2004; 34(2): 111-114.
12. 　Hani MB. A combined laparoscopic and endoscopic approach to acute gastric volvulus associated with traumatic diaphragmatic hernia [J]. Surg Laparosc Endosc Percutan Tech, 2008; 18(2): 151-154.
13. 　王存川, 张松柏, 陈蓥, 等. 腹腔镜疝修补手术222例经验 [J]. 中国普外基础与临床杂志, 2005; 12(6): 551-553.
14. 　魏维强, 柏本健, 解洪涛．电视胸腔镜在创伤性膈疝治疗中的应用 [J]．临床误诊误治, 2008; 21(6)： 69．.
15. 　Ver MR, Rakhlin A, Baccay F, et al. Minimally invasive repair of traumatic right-sided diaphragmatic hernia with delayed diagnosis [J]. JSLS, 2007; 11(4): 481-486.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Treatment and Diagnosis for Closed Loop Intestinal Obstruction asInitial First Presentation of Traumatic Diaphragmatic Hernia

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