超声对腹股沟疝的鉴别分型诊断与其病因学关系的研究  

Relationship between ultrasonic differential diagnosis of inguinal hernia and etiology

作　　者：杨林[1] 向慧娟[1] 周佩[1] 

机构地区：[1]广州军区武汉总医院超声影像科,武汉市430070

出　　处：《临床超声医学杂志》2012年第4期260-262,共3页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨超声检查在腹股沟疝鉴别分型诊断中的价值,为临床选择最佳手术方式提供重要参考。方法对176例临床可疑腹股沟疝患者进行超声检查,记录腹股沟区包块的声像特征、血供、血液运行情况,以及与周围组织、血管的位置关系等,并与手术结果进行对照分析。结果经超声诊断腹股沟疝的176例患者中,与手术结果相符者173例,超声诊断符合率达98.3%。其中斜疝146例,疝门直径<3cm,疝内容物经内环、腹股沟管及皮下环至阴囊局部形成异常团状回声,可见局部腹壁变化,疝囊位于精索静脉前方,内侧可见腹壁下动静脉血流伴行,腹压增大时,疝内容物可见肠壁增厚,层次结构模糊;直疝27例,疝门直径>4cm,疝内容物经直疝三角右后向前不进入阴囊,仅于腹股沟区形成异常回声区,局部腹壁无明显改变,疝囊位于精索静脉内后方,疝囊外侧可见腹壁下动静脉血流束伴行,腹压增大时,疝内容物可见肠壁略变薄,层次结构尚清晰。结论超声可根据疝门大小、腹压变化前后局部腹壁厚度、疝内容物及疝囊与腹壁下动脉位置关系等情况的观察,直观地鉴别斜疝与直疝,是术前诊断及鉴别腹股沟疝分型的首选影像学方法。Objective To explore the value of ultrasound in differential diagnosis and typing of inguinal hernia, andtoprovide important reference for choosing the best way for clinical surgery. Methods One hundred and seventy-six patients with clinical suspicious inguinal hernia underwent uhrasonography, the ultrasonic features and blood supply situation of lesions in groin area, the relationship between surrounding tissue and blood vessels were recorded, the results were compared with those of surgery. Results In 176 patients, there were 173 cases consistent with surgery （173/176, 98.3%）, including 146 cases of indirect hernia, the diameter of hernia door was 〈3 cm, hernia content passed through inner loop, the inguinal canal and subcutaneous ring to scrotum to form abnormal echo mass, the changes of abdominal wall could be observed, the hernial sac was located anterior to the spermatic vein and lateral to inferior epigastric artery and vein. When the abdominal pressure was increased, the thickening of bowel wall was observed with indefinite structure in the hernia content. There were 27 cases of direct hernia, the diameter of hernia door was 〉4 cm, hernia content passed through Hesselbach triangle and went forward to form abnormal echo mass in the groin area, there was no changes in the abdominal wall. The hernial sac was located medical and posterior to the spermatic vein and medical to inferior epigastric artery and vein. When the abdominal pressure was increased, thinning of the bowel wall was observed and the structure was clear in the sac. Conclusion Uhrasound can differentiate direct and indirect hernia according to the size of hernia door, abdominal wall thickness before and after changing the abdominal pressure, relationship between hernia content, hernial sac and abdominal wall artery, it is the first line imaging method for diagnosis and typing of hernia before operation.

关 键 词：超声检查 多普勒 彩色 腹股沟疝 分型 病因学 

分 类 号：R656.21[医药卫生—外科学] R445.1[医药卫生—临床医学]