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題名 | Traumatic Diaphragmatic Hernia: Report of Two Cases=創傷性橫膈膜疝氣:兩病例報告 |
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作者 | 邱偉育; 許正義; | 書刊名 | 臺灣外科醫學會雜誌 |
卷期 | 39:2 民95.03-04 |
頁次 | 頁100-105 |
分類號 | 416.2423 |
關鍵詞 | 創傷性橫膈膜疝氣; Trauma; Diaphragmatic hernia; |
語文 | 英文(English) |
中文摘要 | 創傷性橫膈膜疝氣是一種初期不易診斷的疾病。我們提出兩個病例,第一個病例是二十三歲男性因交通事故造成的胸腹部鈍挫傷合併急性橫膈膜疝氣;另一個病例是六十歲男性因暴力事件造成的胸腹部穿刺傷合併慢性橫膈膜疝氣,此病例在意外發生後二十年才被診斷出來立即性疝氣通常合併較大的橫膈膜撕裂傷,但是臨床症狀常被相關臟器受傷所掩蓋;橫膈膜修補術必須經由剖腹探查,因為同時伴隨腹腔臟器受傷的發生率很高。假如較小的橫膈膜撕裂傷在初期沒有被修補,漸進性的腹腔內臟疝氣會因為胸腔與腹腔的壓力差而被表現出來;開胸手術提供一個較優的暴露空間,可以將疝脫的腹腔臟器與肺實質間的沾黏分開。我們強調創傷性橫膈膜疝氣可以區分為急性和慢性兩類,兩者在治療上各有區別。 |
英文摘要 | Traumatic diaphragmatic hernia (TDH) can be difficult to recognize. We present 2 cases of TDH. One case is a 23-year-old man, who suffered from a blunt injury with acute TDH from a motor vehicle accident. The other case is a 60-year-old male who had chronic TDH due to a violent penetrating injury more than 20 years previously. Immediate herniation is most often associated with a large tear of the diaphragm, but the symptoms of the herniation are usually obscured by other associated injuries. The diaphragmatic repair should be approached through a laparotomy due to the high incidence of simultaneous intra-abdominal organ injury. If small tears of the diaphragm are not repaired initially, progressive abdominal visceral herniation may occur because of the pressure gradient between the thoracic and peritoneal cavities. A thoracotomy provides excellent exposure to divide the adhesions between the trapped viscera and lung parenchyma. We emphasize that there are two types of TDH: acute and chronic. Each of these two types has its own treatment modality. |
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