Evolution in the management of traumatic diaphragmatic injuries: A multicenter review

被引:29
作者
Ties, Jill S. [1 ]
Peschman, Jacob R. [4 ]
Moreno, Andres [6 ]
Mathiason, Michelle A. [2 ]
Kallies, Kara J. [2 ]
Martin, Ronald F. [7 ]
Brasel, Karen J. [5 ]
Cogbill, Thomas H. [3 ]
机构
[1] Gunderson Med Fdn, Dept Med Educ, La Crosse, WI USA
[2] Gunderson Med Fdn, Dept Res, La Crosse, WI USA
[3] Gundersen Hlth Syst, Dept Gen & Vasc Surg, La Crosse, WI 54601 USA
[4] Med Coll Wisconsin, Dept Med Educ, Milwaukee, WI 53226 USA
[5] Med Coll Wisconsin, Dept Surg, Milwaukee, WI 53226 USA
[6] Marshfield Clin Fdn Med Res & Educ, Dept Med Educ, Marshfield, WI USA
[7] Marshfield Clin Fdn Med Res & Educ, Dept Surg, Marshfield, WI USA
关键词
Diaphragmatic trauma; penetrating diaphragm injuries; blunt diaphragm injuries; minimally invasive repair of traumatic diaphragmatic injury; LAPAROSCOPIC REPAIR; RUPTURE; EXPERIENCE; DIAGNOSIS; HERNIA; SCAN;
D O I
10.1097/TA.0000000000000140
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND Traumatic diaphragmatic injury (TDI) is uncommon and has historically been identified by chest x-ray and repaired by laparotomy with nonabsorbable suture. Blunt TDI was more frequently (90%) detected on the left. With advances in imaging and operative techniques, our objective was to evaluate evolution in incidence, location, and management of TDI. METHODS The medical records of patients admitted to three Wisconsin regional trauma centers with TDI from 1996 to 2011 were reviewed. Patients were stratified into blunt and penetrating injury and early (1996-2003) and recent (2004-2011) periods. p < 0.05 was significant. RESULTS A total of 454 patients was included, 87% were men. Median Injury Severity Score (ISS) was 22 and 19 in the early and recent periods, respectively. Diagnostic modality for TDI did not change over time when comparing chest x-ray, computed tomography, or intraoperative diagnosis for blunt (p = 0.214) or penetrating (p = 0.119) TDI. More right-sided penetrating TDI were identified in the recent versus early group (49% vs. 27%). Perihiatal injury was rare (2%). Minimally invasive repairs increased in the recent versus early group of penetrating TDI (5.8% vs. 0.9%, p = 0.040). Complex repairs (mesh, transposition) were required in only three patients. In-hospital mortality was 15% and 4% for blunt and penetrating TDIs, respectively (p < 0.001). CONCLUSION A large increase in the frequency of both blunt and penetrating TDIs in our region was documented. While no difference was observed regarding diagnosis of blunt TDI during the two study periods, our data show a change from historical reports; more injuries were detected by computed tomography. An increase in right-sided penetrating TDI was also observed. A small but previously unreported incidence of perihiatal/pericardial injury occurred with both blunt and penetrating TDIs. While the majority of injuries were repaired with laparotomy, minimally invasive repairs were used more frequently in the recent period. LEVEL OF EVIDENCE Epidemiologic study, level III. Therapeutic study, level IV.
引用
收藏
页码:1024 / 1028
页数:5
相关论文
共 27 条
[1]   Diaphragmatic rupture: Is management with biological mesh feasible? [J].
Al-Nouri, Omar ;
Hartman, Brett ;
Freedman, Robert ;
Thomas, Casey ;
Esposito, Thomas .
INTERNATIONAL JOURNAL OF SURGERY CASE REPORTS, 2012, 3 (08) :349-353
[2]   Bilateral diaphragm rupture: A unique presentation [J].
Anderson, DW .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2002, 52 (03) :560-561
[3]   Diaphragmatic injuries after blunt trauma: Are they still a challenge? Reviewing CT findings and integrated imaging [J].
Giorgio Bocchini ;
Franco Guida ;
Giacomo Sica ;
Umberto Codella ;
Mariano Scaglione .
Emergency Radiology, 2012, 19 (3) :225-235
[4]   CT reconstructions of right-sided blunt diaphragm rupture [J].
Dineen, Sean ;
Schumacher, Paul ;
Thal, Erwin ;
Frankel, Heidi .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2008, 64 (05) :1412-1412
[5]   Acute traumatic diaphragmatic ruptures: A retrospective study of 48 cases [J].
Dirican, Abuzer ;
Yilmaz, Mehmet ;
Unal, Bulent ;
Piskin, Turgut ;
Ersan, Veysel ;
Yilmaz, Sezai .
SURGERY TODAY, 2011, 41 (10) :1352-1356
[6]  
Dwivedi Sankalp, 2010, J Emerg Trauma Shock, V3, P173, DOI 10.4103/0974-2700.62122
[7]   Imaging of diaphragmatic rupture after trauma [J].
Eren, S. ;
Kantarci, M. ;
Okur, A. .
CLINICAL RADIOLOGY, 2006, 61 (06) :467-477
[8]   Diaphragmatic hernia:: diagnostic approaches with review of the literature [J].
Eren, S ;
Çiris, F .
EUROPEAN JOURNAL OF RADIOLOGY, 2005, 54 (03) :448-459
[9]   Diaphragmatic transposition: An elegant procedure for large traumatic chest wall defects [J].
Frye, WA ;
Cogbill, TH ;
Patel, NY .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2005, 59 (06) :1507-1509
[10]   The current status of traumatic Diaphragmatic injury: Lessons learned from 105 patients over 13 years [J].
Hanna, Waeel C. ;
Ferri, Lorenzo E. ;
Fata, Paola ;
Razek, Tarek ;
Mulder, David S. .
ANNALS OF THORACIC SURGERY, 2008, 85 (03) :1044-1048