Acute and chronic traumatic diaphragmatic hernia: 10 years’ experience


Autoři: Pengcheng Gu aff001;  Yang Lu aff001;  Xigong Li aff002;  Xiangjin Lin aff001
Působiště autorů: Trauma centre, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China aff001;  Department of Orthopedics, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China aff002
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226364

Souhrn

Controversy persists regarding many aspects of traumatic diaphragmatic hernia (TDH). We aimed to understand why some traumatic diaphragmatic injuries present with chronic hernia and to evaluate diagnosis and treatment options. Fifty acute and 19 chronic TDH patients were diagnosed and treated at our institution over a 10-year period. Clinical data from these two groups were analyzed statistically and compared. Chronic TDH patients had a significantly lower Injury Severity Score than acute TDH patients (10.26 ± 2.68 vs. 26.92 ± 4.79, P < 0.001). The most common surgical approach for acute and chronic TDH was thoracotomy and laparotomy, respectively. The length of the diaphragmatic rupture was significantly shorter in chronic TDH patients than acute TDH patients (6.00 ± 1.94 cm vs. 10.71 ± 3.30 cm, P < 0.001). The mean length of hospital stay was significantly longer for acute TDH patients than chronic TDH patients (41.18 ± 31.02 days vs. 16.65 ± 9.61 days, P = 0.002). In conclusion, milder trauma and a smaller diaphragmatic rupture were associated with delayed diagnosis. A thoraco-abdominal computed tomography scan is needed for patients with periphrenic injuries to avoid delayed diagnosis of TDH. Improved awareness and understanding of diaphragmatic injuries will increase the rate of early diagnosis and improve prognosis.

Klíčová slova:

Diagnostic medicine – Hernia – Laparotomy – Surgical and invasive medical procedures – Surgical repair – Thoracotomy – Traumatic injury – Thoracic diaphragm


Zdroje

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2019 Číslo 12