裂孔型膈疝疝囊积液多层螺旋CT表现  

Multislice CT and Clinical Manifestations of Diaphragmatic Hiatus Hernia with Hernial Sac Effusion

作　　者：刘婷婷[1] 曹和涛[1] 李宁[1] 于芹[1] 侯冬梅[1] 

机构地区：[1]南通大学附属医院影像科,江苏南通226001

出　　处：《中国医学影像学杂志》2015年第12期938-942,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨裂孔型膈疝疝囊积液的多层螺旋CT及临床表现,以提高其诊断率。资料与方法回顾性分析32例裂孔型膈疝疝囊积液的CT资料,分析裂孔型膈疝疝囊积液的形态特征及临床表现。结果 32例患者中,男21例,女11例（χ^2=0.64,P〉0.05）。〉60岁25例,≤60岁7例（χ^2=13.58,P〈0.01）。非脏器型裂孔疝27例,其中脂水混合型23例,单纯积液型4例;脏器型裂孔疝5例（χ^2=5.47,P〈0.05）。伴腹腔积液28例,其中非脏器型裂孔疝23例,脏器型裂孔疝1例（χ^2=9.56,P〈0.01）。非脏器型裂孔疝疝囊积液横断位依层面高低呈类圆形、弯月、环状和水滴状,多平面重组主要呈弯月和倒水滴状;脏器型裂孔疝疝囊积液形态不规则。患者临床症状主要有吞咽困难、胸闷和上腹部不适。结论胸腹腔压力梯度差增大驱使腹水进入膈上疝囊或裂孔卡压可能是裂孔型膈疝疝囊积液的主要形成机制。类圆形、弯月、环状和水滴状是裂孔疝疝囊积液的特殊形态,且与腹腔相通。Purpose To explore the multislice CT（MSCT） and clinical manifestations of diaphragmatic hiatus hernia with hernial sac effusion, in order to improve its diagnostic rate. Materials and Methods MSCT data were retrospectively analyzed for morphologies and clinical manifestations in 32 patients with diaphragmatic hiatus hernia and hernial sac effusion. Results 32 patients included 21 males and 11 females（χ~2=0.64, P〉0.05）. 25 patients were older than 60 years and 7 cases younger than 60 years（χ~2=13.58, P〈0.01）. There were 27 cases with non-viscera hiatus hernia including 23 cases of combined fatwater hernia and 4 cases of simple effusion. 5 cases were of viscera type hiatus hernia（χ~2=5.47, P〈0.05）. 28 cases showed ascites including 23 cases with non-viscera hiatus hernia and 1 case with viscera type hiatus hernia（χ~2=9.56, P〈0.01）. The axial images from different levels of non-viscera hiatus hernia with liquid hernial sac demonstrated ＂quasicircular＂, ＂meniscus＂, ringlike and ＂teardrop＂ shapes.Viscera type hiatus hernia and liquid hernial sac were found to be irregular shape. All patient sufferered from dysphagia, chest distress and epigastric discomfort. Conclusion The increased pressure gradient between thorax and abdomen driving ascites into supradiaphragmatic hernial sac and clamping by hiatus may be the main mechanism. ＂Quasi-circular＂, ＂meniscus＂, ＂ringlike＂ and ＂teardrop＂ were the characteristic signs of diaphragmatic hiatus hernia with hernial sac effusion.

关 键 词：疝 横膈 水肿 体层摄影术 螺旋计算机 

分 类 号：R445.2[医药卫生—影像医学与核医学] R656.24[医药卫生—诊断学]