中老年非外伤性食管裂孔疝二维及三维超声诊断研究  

Study on two-dimensional and three-dimensional ultrasonic diagnoses of nontraumatic esophageal hiatal hernia in middle-aged and elderly people

作　　者：王子干 许春梅[1] 朱建常 周峰[1] 张楠[1] 陈鹏[1] 罗洲[1] 杜明明[1] 苏夏夏 

机构地区：[1]安徽省淮北市妇幼保健院超声科淮北市超声中心,235000

出　　处：《中华医学超声杂志（电子版）》2014年第4期48-53,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨经腹部二维及三维超声在中老年非外伤性食管裂孔疝（HH）诊断中的临床价值。方法采用饮水胃充盈法对32例中老年患者行半坐位、立位、仰卧位等多体位二维及三维超声检查并与X线钡餐造影、内镜检查和手术检查结果对照分析。结果32例中老年HH患者经腹部二维及三维超声表现：（1）膈肌食管裂孔增宽（前后径0.9-2.5，平均1.6±0.4 cm）及膈上疝囊，膈上疝囊中见胃黏膜回声10例；超声诊断滑动性HH 27例，食管旁型HH 3例，短食管型HH 2例。同期检查的正常中老年食管裂孔无增宽（前后径0.7-1.5，平均1.0±0.2 cm），无膈上疝囊。（2）实时三维超声沿膈肌食管裂孔长轴观显示32例HH膈上囊腔呈“蘑菇状”或“池塘样”，疝囊颈部呈不规则“坑道样”或“沟壑样”；从胃底面向上观察可见膈上裂孔呈“洞穴样”或“天窗样”；从纵隔面向下观察可见膈上裂孔呈“凿孔状”。超声诊断与X线钡餐造影（32例）、内镜（13例）和手术检查（4例）结果均符合。结论经腹部二维超声可准确诊断中老年人非外伤性HH；实时三维超声可清晰显示疝口的范围、大小、形态，二维及三维超声联合应用可为临床诊断中老年人非外伤性HH提供更全面的诊断信息。Objective To discuss the clinical values of two-dimensional and three-dimensional diagnoses of nontraumatic esophageal hiatal hernia （HH） in middle-aged and elderly people. Methods Thirty-two cases underwent two-dimensional and three-dimensional ultrasonic examination with fasting and water iflling methods in half-sitting, standing, supine and supine right anterior oblique positions. The ifndings were compared with X-ray barium meal examination, endoscopy and operation. Results There were 27 cases sliding HH, 3 cases paraesophageal HH and 2 cases short HH. Traditional two-dimensional manifestations were as follows：widening of hiatal diaphragmatic muscles （1.6±0.4 cm） and echoes of gastric mucosa in superior hernial sac and inside hernial sac. Real-time three-dimensional surface image formations were as follows： along the long axis of diaphragmatic hiatus, superior phrenic sac was showed as mushroom-shaped or pond-shaped and the neck of hernial sac was showed as irregular tunnel-shaped or ditch-shaped;looking upward from the fundus of stomach, superior phrenic hiatus was showed as caved-shaped or louver-shaped;looking downward from mediastinal surface of lung, uperior phrenic hiatus was showed as piercer-shaped. Conclusions Two-dimensional abdominal ultrasound can diagnose nontraumatic HH in middle-aged and elderly people conveniently and accurately. Real-time three-dimensional abdominal ultrasound can display the range, size, and shape clearly. Compared with the former, the latter can provide more information for diagnosis and help ultrsound doctors and clinical doctors to understand and master the anatomical and＆amp;nbsp;morphopathological features of this disease.

关 键 词：超声检查 疝 食管裂孔 成像 三维 

分 类 号：R445.1[医药卫生—影像医学与核医学] R655[医药卫生—诊断学]