The problems in manifestation,diagnosis and treatment of traumatic diaphragmatic rupture

Objective To investigate the problems in manifestation,diagnosis and treatment of traumatic diaphragmatic rupture( TDR). Methods The clinical data of 54 TDR patients from Jan. 1980 to Jan. 2015 were retrospectively analyzed. There were 43 males and 11 females,with an average age of 36 ± 16. 2( range,7-68 year old). There were 48 cases of left phragmatic rupture and 6 cases of right phragmatic rupture. The rate of open and closed diaphragmatic rupture were 10. 0%( 1 /10) and 90. 9%( 40 /44),respectively( P 0. 01). Results Thirtyone patients were not diagnosed within 24 hours following admission( 57. 4%). The rate of misdiagnosis and delayed diagnosis were 14. 8%( 8 /54) and 42. 6%( 23 /54),respectively( P 0. 01). The diagnosed rate of X ray,CT,and ultrasonic examination were 51. 4%( 19 /37),87. 5%( 28 /32) and 56. 3%( 9 /16),respectively. Twentythree cases were diagnosed by 2 or 3 examinations. There were signification differences between CT examination and X ray examination or ultrasonic examination( P 0. 05). Forty-one diaphragmatic hernia cases were found hard to return during operations and 29. 3% of them adhered with thoracic cavity. Nine cases were treated by surgery because of necrosis or strangulation. In this study,51 cases were cured( 94. 4%),3 cases died because of traumatic shock,severe head injury,and multiple organ dysfunction failure with an average injury severity score( ISS) of 42. 4points. Conclusion The main diagnosis basis of TDR is double cavities after trauma and imaging examination.Early diagnosis,reasonable choices of surgical methods and active management of associated injuries are main concerns in clinical application.