MSCT对腹内疝的临床应用价值  

The clinical value of MSCT in diagnosis of internal abdominal hernia

作　　者：蔡红法[1] 陈颖[1] 陈双庆[1] 沈玉英[1] 施海华[2] 

机构地区：[1]南京医科大学附属苏州医院 苏州市立医院东区放射科,江苏苏州215001 [2]南京医科大学附属苏州医院 苏州市立医院东区普外科,江苏苏州215001

出　　处：《实用放射学杂志》2015年第3期420-423,共4页Journal of Practical Radiology

摘　　要：目的：分析腹内疝多层螺旋CT（MSCT）的表现,探讨其对临床的应用价值。方法回顾性分析经手术证实的15例腹内疝患者的临床资料和 MSCT表现。结果 15例患者中14例术前 MSCT表现为小肠梗阻,1例无明显肠梗阻,8例表现肠管绞窄。腹内疝特征性CT表现为：异位的肠管组织（占位效应）,闭襻性肠梗阻,扩张的肠襻呈囊袋状、簇状聚集；绞窄性肠梗阻出现肠系膜血管聚集、增粗充血、拉伸、移位和扭曲,肠壁缺血水肿、增厚,密度异常。15例中经手术证实十二指肠旁疝2例,经网膜疝2例,经肠系膜疝5例,粘连性束带疝4例,盲肠周围疝1例,Douglas窝疝1例。术中发现肠梗阻14例,无明显肠梗阻1例,肠管绞窄8例。各类型腹内疝的CT表现与手术结果存在相关性,MSCT对肠梗阻的分级与手术结果评定一致（Kappa=0.758,t=3.462,P=0.001）。结论 MSCT能对多数腹内疝作出准确诊断,并能正确分级肠梗阻,有助于评估病情,指导手术方案的选择。Objective To investigate the clinical value of multi-slice spiral CT （MSCT）in diagnosis of internal abdominal hernia （IAH）.Methods The MSCT findings in 1 5 patients with IAH confirmed by surgery were retrospectively analyzed.Results MSCT showed intestinal obstruction in 14 patients with strangulating intestinal obstruction in 8.The typical features of MSCT were as follows：translocated position of intestines （occupying effect）,closed loop intestinal obstruction （gathered intestinal loops with different forms）,assembled,expanded and translocated blood vessels of mesenteries,and thickened intestinal walls with ischemic edema and abnormal density.Surgical results showed paraduodenal hernia in 2,transomental hernia in 2,transmesenteric hernia in 5,ankylenteron strap hernias in 4,pericecal hernia in 1 and hernia through the Douglas fossa in 1,Intestinal obstruction in 14 and strangulating intestinal obstruction in 8 were also confirmed by surgery.The CT findings of IAH were correlated with the surgical results,and the accurate rate of grading of intestinal obstruction with CT was also consistent with the surgical results （Kappa=0.758,t=3.462,P=0.001）.Conclusion IAH can be diagnosed accurately by MSCT in most patients,MSCT is helpful for guiding the surgical programs.

关 键 词：腹疝 计算机体层成像 

分 类 号：R656.24[医药卫生—外科学] R814.42[医药卫生—临床医学]