目的报告32例膈肌破裂与创伤性膈疝的诊治体会。方法对该院收治的32例创伤性膈肌破裂进行回顾性分析。结果该32例中，开放性损伤12例，闭合性损伤20例，26例并发创伤性膈疝。经X线检查，18例有阳性发现； 16例行CT检查，结果均为阳性； 术前确诊24例（75%），治愈28例，死亡4例（12.5%）。结论CT和X线检查是诊断膈肌破裂和创伤性膈疝的主要依据。早期诊断、及时手术治疗是提高治愈率、降低死亡率的关键。
Objective To explore the mechanism of pulmonary hypoplasia in case of congenital diaphragmatic hernia (CDH), and study the ultramicrostructural features of lung tissue of CDH fetal rat models at different developmental stages. Methods Seven SpragueDawley (SD) pregnant rats were randomly divided into CDH group (n=4) and control group (n=3). For the rats in the CDH group, Nitrofen was used to fill in the stomach once at day 9.5 of pregnancy (125 mg of Nitrofen dissolved in 2 ml of olive oil each), and 3, 10, 17 fetal rats were collected at day 16, 18 and 21 of pregnancy respectively. For the rats in the control group, 2 ml of olive oil was used to fill in the stomach, and 10 fetal rats were collected at day 16, 18, and 21 of pregnancy respectively. The lung tissue sections of the fetal rats collected on day 16 were observed under transmission electron microscope (TEM). For the lung tissue of the fetal rats collected on day 18, hematoxylineosin (HE) staining and TEM observation were performed and the incident of CDH was detected. Besides the procedures carried out for the rats collected on day 18, the ratio of fetal lung to body weight was observed for the lung tissue of the fetal rats collected on day 21. Results (1) The ratio of fetal lung to body weight of fetal rats in the CDH group was significantly lower than that of fetal rats in the control group (0.0238 vs. 0.0430, Plt;0.01). The incidences of CDH in the 18thday and 21stday fetal rats in the CDH group were 90.00% and 82.35%respectively, while no CDH was observed in the corresponding fetal rats in the control group, suggesting pulmonary hypoplasia in the CDH group. (2) The ultramicrostructural observation showed that compared with the control group, pulmonary hypoplasia appeared in 16thday fetal lungs in the CDH group, i.e., broad breathing barrier substrate, little contents, predominant euchromatin and rich ribosomes in the alveolar epithelial cells, and no microvilli in the bronchial lumen. The observation on the 18thday and 21stday samples suggested that, with the progressing of pregnancy, the abovementioned features became more obvious. (3) Typical lamellated body was observed in fetal lung type Ⅱ alveolar epithelial cells from the 21stday fetuses in both the CDH group and the control group, suggesting that some late subcellular structures were normal. Conclusion Lung hypoplasia develops in the early period of fetal rats with CDH rather than in the late period, implying that the treatment of pulmonary hypoplasia of diaphragmatic hernia should be performed in the early stage of lung development.
The management of neonates with high risk congenital diaphragmatic hernia (CDH) which gives rise to respiratory distress syndrome in 6 hours after born is so troublesome that the mortality is very high. The past advocation that CDH should accept emergency operation has been called in question. Another therapeutic procedure is recommended that CDH repair operation should be performed after the respiration and circulation has been stabilized. This procedure has presented better effect than before. The present advances in the management including general measures, mechanical ventilation, extracorporal membranous oxygenator (ECMO), nitric oxide (NO) inhalation, glucocorticoid, pulmonary surfactant, CDH repair and so on were reviewed.
Objective To summarize the clinical characteristics, diagnosis and treatment of Bochdalek hernia in neonates and infants. Methods The data of 15 neonates and 10 infants with Bochdalek hernia，undergoing the normal diagnosis and surgical repair from August 1983 to June 2004, were retrospectively reviewed. Location was left in 22 cases and right in 3 cases. Twenty-four cases were treated by operation and 1 case died of respiratory failurebefore operation.Results Before April 1998，7 of 8 (5 neonates，3 infants) cases of Bochdalek hernia stayed healthy and respiratory symptomfree 1 year after operation; they were followed up 1 year and 3 months to 11 years. One premature neonate with Bochdalek hernia died of respiratory failure before operation, and his lung volume was found to be dysplasia. From April 1998 to June 2004, 15（8 neonates，7 infants） of 17 （10 neonates，7 infants）cases of Bochdalek hernia survived postoperatively, while 2 neonates died of respiratory failure. Conclusion The earlier dyspnoea of neonates ofBochdalek hernia occur，the worse their healthy status appear. The standard andtimely surgical repairs could improve the curative ratio. Whether the operationwas suspended depended on the healthy states of babies.
Objective To investigate the effect of the traditional Chinese medicine “Tetrandrine”(TET) and its significance on epidermal growth factor(EGF) and its receptor(EGFR) in the lung of nitrofen-induced congenital diaphragmatic hernia(CDH) rat model. Methods Twenty female rats were given maternal administration of a single oral dose (115 mg/rat) of nitrofen to induce CDH at 9.5 days after pregnancy and were dividedinto normal solution group(NS, n=5), dexamethasone group (Dex, n=5),tetrandrine group (TET, n=5) and Dex+TET group(n=5) at 18.5 days; 4 rats were given edible oil as controls. All fetuses were delivered by cesarean section at 21.5 days. Lung histologic evaluations and EGF, EGFR immunohistochemical staining and image analysis were performed. Results CDH was observed in 64 of the 137 rat fetuses (46.7%) in the experimental groups; no CHD was observed in 36 rat fetuses of control group. The lungs of CDH fetuses showed marked hypoplasia in NS group, in contrast to improved mesenchymal differentiationin that of Dex, TET, Dex+TET groups. The expression of EGF was weaker and weaker and that of EGFR was ber and ber as following order: NS, TET, DEX, T+D and control groups; showing significant differences between them (Plt;0.05). Conclusion Prenatal TET administration shows marked improvement in pulmonary hypoplasia through preregulating crest-time of EGF expression and upregulating EGFR expression in the lungs of nitrofen-induced CDH rat model. A combination of TET and Dex would generate evident synergistic effect.
Congenital deformities of the diaphragm include (1) Hiatus hernia; (2) Congenital diaphragmatic hernia; (3) Eventration of deaphragm. Fifty-one cases were seen by the authors in the past 30 years. Each type of the pathologic feature and the experiences in the surgical repair were suggested in this paper. Choice of an appropriate surgical procedure on the basis of its pathoanatomic and pathophysiologic features was emphasized in order to enhance the efficacy of treatment.
目的 分析创伤性膈疝的诊断、外科治疗和预后。 方法 对1999年1月-2010年1月收治的16例创伤性膈疝的临床资料进行回顾性分析。 结果 16例均行手术治疗，胸腹腔脏器损伤处理后行膈肌修补，2例手术后死亡，14例痊愈出院。 结论 创伤性膈疝常合并多发伤，胸腹部X线平片、钡餐检查及胸部、上腹部ＣＴ扫描不仅能对膈疝做出正确的诊断，对临床手术指导具有重要的意义。诊断一旦明确，须及时手术治疗，方能降低病死率。
目的:探讨急性创伤性膈疝的诊疗体会。方法:对2000年1月至2008年12月我院收治的22例急性创伤性膈疝的创伤原因、临床表现、辅助检查以及治疗方法进行回顾性分析。结果:术前确诊20例,术中确诊2例,手术治愈21例,死亡1例,平均住院16～25天。结论:急性创伤性膈疝极易发生绞窄,且容易被合并伤所掩盖,所以早期的诊断和治疗就尤为重要。
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。