Diagnosis And Therapy Of Traumatic Diaphragmatic Rupture

Objective: To investigate diagnosis and therapy of traumatic diaphragmatic rupture (TDR). Through systematic review of standard therapy for the TDR program to provide clinical references.Methods: 67 patients with TDR were collected in Ninth People's Hospital of Chongqing and Second Affiliated Hospital of Chongqing Medical University from July 1998 to October 2009, and a retrospective analysis was performed. Left-sided TDR was found in 59 patients (88.1%), right in 7 (11.7%) and Bilateral in 1(0.2%),46 diaphragmatic hernias, 65 complicated with thoracic-abdominal organs injury. Imageology examination (thoracic-abdominal X-ray and computerized topography) was performed preoperatively in 60 cases. Injury severity score (ISS) was (21.3±8.1). 67 patients underwent emergency surgery.Results: In all patients, the incidence of TDR in left side more than right (P<0.01) ,male was more than that of female (P<0.01). The diagnostic accordance rate of computed tomography was 69.8% and preoperative diagnosis rate was 64.2%. Emergency operations were performed in 62 patients and no Serious postoperative complications were observed. Another 5 died.Conclusion: When faced with more severe chest and abdominal trauma, should be alert to the occurrence of TDR. The early diagnosis depends on history, physical examination and imageology examination, and aggregate analysis should be preformed. CT diagnosis of diaphragmatic rupture of the highest value, should be routine examination. Selecting operative opportunity, treatment process, approach and repair modes correctly would increase achievement rate of the therapy and decrease incidence rate of the complications in patients with TDR. Thoracic surgery for the majority of traumatic diaphragmatic rupture is the best means.