多层螺旋 CT 在腰疝诊治中的意义  

The role of multi-slice spiral CT in diagnosis and treatment of lumbar hernia

作　　者：吴茂铸 汪官富[2] 倪淑红 赵年家 王芬 韩子华 

机构地区：[1]浙江省台州恩泽医疗中心集团路桥医院放射科,浙江台州318050 [2]浙江省台州恩泽医疗中心集团路桥医院泌尿外科,浙江台州318050 [3]浙江省台州恩泽医疗中心集团路桥医院门诊部,浙江台州318050

出　　处：《实用放射学杂志》2015年第8期1297-1300,共4页Journal of Practical Radiology

摘　　要：目的：探讨腰疝（LH）的多层螺旋 CT（MSCT）表现特征及后处理重建技术在 LH 诊治中的临床价值。方法收集经手术病理证实的 LH 16例,回顾性分析其临床和影像学资料。结果 MSCT 诊断 LH 16例共17疝,其中腰上三角疝12例13个（76.5%）,腰下三角疝3例（17.6%）,弥漫性 LH 1例（5.9%）。疝环直径约1.5-9.3 cm,疝囊大小约1.8 cmx2.4 cm-11.3 cmx6.2 cm。LH 在 MSCT 上表现为腹腔、腹膜后组织或器官经缺损的腰三角间隙向腰背部皮下、皮下软组织内突出的类圆形或烧瓶样肿块。腰上三角疝上界为第12肋下缘,外界为腹内斜肌内缘,内界为竖脊肌、腰方肌的外缘。腰下三角疝的内界为背阔肌前缘,外界为腹外斜肌后缘,下界为髂嵴。17个 LH 中,疝内容物为结肠及其系膜3例,小肠2例,其中1例为嵌顿性 LH 合并小肠梗阻,其余12个 LH 的内容物均为后腹膜脂肪组织及系膜。16例均行疝修补术,术前依据 MSCT 表现选择合适的手术修补方式,术中均符合LH,术后随访均无复发。结论 LH 具有特征性 CT 表现,MSCT 容积扫描结合后处理重建能清晰显示 LH 的类型、大小、疝内容物以及并发症发生情况,能为 LH 的诊断和鉴别诊断以及疝修补术提供重要的信息。Objective To explore the imaging appearances and the value of multi-slice CT （MSCT）with post-processing tech-niques in diagnosis and treatment of lumbar hernia （LH）.Methods The imaging and clinical data of 1 6 patients with LH which were confirmed by surgery were analyzed retrospectively.Results In 1 6 patients,1 7 lesions of LH were revealed by MSCT.There were superior lumbar hernias in 13 （76.5%）,inferior lumbar hernias in 3 （1 7.6%）and diffuse lumbar hernia in 1 （5.9%）.Hernia ring in diameter ranged from 1.5 to 9.3 cm,and the hernia sac size ranged from 1.8 cmx2.4 cm to 1 1.3 cmx 6.2 cm.MSCT showed oval or flask shaped mass of extraperitioneal fat with or without peritoneum and visceral contents protruded through the de-fecting fascia floor into lumbar triangle.Superior lumbar hernia was bounded by the 12th rib superiorly,the erector spine muscle medially and the internal oblique muscle laterally.Inferior lumbar hernia was bounded by latissimus dorsi muscle medially,the ex-ternal oblique muscle laterally and the iliac crest inferiorly.Hernia contents included colon in 3 patients and small bowel in 2 with in-carcerated hernia with small bowel obstruction in 1,and adipose tissue and mesentery in other 12.All patients received surgery treatment,and the appropriate surgical methods were selected according to the MSCT findings.The surgical findings were consistent with MSCT results.No recurrence was found during follow-up.Conclusion LH has characteristic CT manifestations.MSCT volu-metric scanning with post-processing techniques can clearly display the type of LH,the size of abdominal wall defect,hernia contents and their complications.It is helpful for diagnosis of the LH and differentiation from other diseases,which may provide important information for clinical surgery.

关 键 词：腰疝 后处理重建 计算机体层成像 

分 类 号：R656.2[医药卫生—外科学]