医源性膈疝MSCT多平面重组表现  

MSCT Multi-Planar Reformation Findings of Iatrogenic Diaphragmatic Hernia

作　　者：黄理华 曹和涛[2] 于芹[2] 苏海[2] 田浩[2] 刘婷婷[2] 陈小华[2] 

机构地区：[1]江苏省海门市人民医院放射科,226100 [2]江苏省南通大学附属医院影像科,226001

出　　处：《临床放射学杂志》2015年第5期752-755,共4页Journal of Clinical Radiology

摘　　要：目的分析食管癌术后继发医源性膈疝(IDH)的MSCT多平面重组(MPR)表现,探讨其诊断价值。方法回顾性分析2010年1月至2014年3月间食管癌术后继发IDH 16例。将其CT号随机混编入其他50例食管癌术后无食管裂孔(EH)扩大患者队列,由2名不知研究目的从事腹部影像诊断的高年资医师分别就横断位和MPR图像进行判断。对不同医师、不同方法判断结果及影像表现差异采用χ2检验。结果 16例IDH中3例局限性于EH,横断位2例呈假"肠套叠"征,1例呈肠扭转表现;MPR直观显示肠管挤入EH顶压胸腔胃呈"壁贴壁征"。13例超出EH范围,横断位表现为胸腔内肠管于各方向汇聚于EH处胸腔胃,其中,前外、后外及前后外侧分别为9例、5例和2例,前外侧明显多于前后外侧(χ2=6.79,P<0.05),2例并肠系膜扭转;MPR直观显示胸腔内管肠及其系膜血管通过EH与腹腔相应结构连通。由2名医师横断位提示IGH诊断分别为3例和4例,MPR全部提示IDH诊断,均显著高于横断位(χ2=21.89,19.20,P值均<0.05)。结论食管癌术后继发IDH横断位表现隐匿,仔细观察并及时辅以MPR,对诊断具有重要意义。Objective To analyze the MSCT multiplanar reformation （MPR） manifestations of iatrogenie diaphragmatic hernia （IDH） occurring after esophageal surgery for esophageal cancer, and to discuss its diagnostic value. Methods MSCT materials of 3015 patients with esophageal cancer, who were admitted to authors＇ hospital to receive esophageal surgery during the period from January 2010 to March 2014, were retrospectively analyzed. A total of 16 patients who had IDH secondary to esophageal surgery were collected. Their CT numbers were randomly mixed into the queue of other 50 patients who showed no dilatation of esophageal hiatus （EH） after esophageal surgery. The axial and MPR images were separately evaluated by two senior radiologists, who did not know the purpose of the study and who engaged in the abdominal imaging diagnosis. The differences in the diagnostic judgments and imaging features between the two radiologists were evaluated by X2 test.. Results Of the 16 patients with IDH, the bowel was localized in EH in 3, presenting as false ＂intussuscep- tion＂ on cross section （ n = 2） and sign of volvulus （n = 1 ）. On MPR, the bowel squeezed into EH to oppress the thoracic stomach producing ＂wall stick wall＂ sign. In 13 patients, the hernia was beyond the range of EH, presenting as conver- gence of intrathoracic bowel toward EH, the direction of convergence were anterolateral （ n = 9）, posteriorlateral （ n = 5 ） or to the left side （ n = 2）. The difference in the convergence direction was statistically significant （X2 = 6.79,P 〈 0.05 ）. In two patients the hernia was associated with mesenteric torsion. MPR directly displayed the communication of intrathoracic bowel and mesenteric blood vessels with the corresponding structures in abdominal cavity through EH. The diagnosis of IDH, judged by the two radiologists, was made in 3 and 4 patients respectively. MPR could suggest the diagnosis of IDH for all patients, which was significantly higher than that suggested by cross-sectio

关 键 词：食管裂孔 膈疝 医源性 体层摄影术 X线计算机 

分 类 号：R655.6[医药卫生—外科学] R816.5[医药卫生—临床医学]