超声对隐匿性腹股沟疝的诊断价值  

Ultrasonography in diagnosing occult groin hernia

作　　者：蒋智明[1] 徐恩 夏雪峰[1] 张凯[1] JIANG Zhiming;XU En;XIA Xuefeng;ZHANG Kai(Department of General Surgery,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院普外科,南京210008

出　　处：《中华实用诊断与治疗杂志》2020年第7期726-727,共2页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金青年基金(81501380)。

摘　　要：目的探讨隐匿性腹股沟疝患者超声声像特征及超声诊断价值。方法 297例腹股沟部位疼痛患者,均行超声检查,记录其超声声像特征,超声诊断腹股沟疝的情况。以手术为金标准,计算超声诊断隐匿性腹股沟疝的灵敏度、特异度及准确率。结果超声诊断腹股沟疝167例,其中136例疝内容物超声声像提示为肠袢,表现为可蠕动的、迂曲的液性管道状回声,部分可见肠内容物回声及气体回声;31例疝内容物超声声像特征为大网膜,表现为较周围脂肪更强回声,平静或探头加压可部分或全部纳入腹腔,腹压增大偏强回声范围增大;116例行手术探查,其中107例确诊为腹股沟疝,9例未发现腹股沟疝。130例超声未发现腹股沟疝者,6例由于腹股沟部位疼痛加重而行手术探查,5例诊断为腹股沟疝,1例诊断为淋巴结肿大,余124例门诊随访症状改善。以手术为金标准,超声诊断腹股沟疝的灵敏度为95.5%,特异度为10%,准确率为88.5%。结论超声可有效诊断隐匿性腹股沟疝,但假阴性高,对超声未发现腹股沟疝者应密切观察,必要时行手术探查。Objective To investigate the performance of ultrasonography of occult groin hernia and its diagnostic value.Methods Totally 297 patients with groin pain received ultrasonography examination,and the features of ultrasonography were recorded.The sensitivity,specificity and accuracy of ultrasonography in diagnosing occult groin hernia were evaluated based on operation findings.Results In 167 patients with ultrasonographically diagnosed groin hernia,136 were found a loop of intestine in hernia,featured by peristaltic and tortuous liquid tubular echo,some of which were featured by echo of intestinal contents and gas echo;while the ultrasonographic performances of the hernia contents in the other 31 patients were greater omentum,showing stronger echogenic echo compared with the peripheral fat,placidity or pressure of the probe was partially or completely incorporated into the abdominal cavity,and the range of echogenicity increased with the increase of abdominal pressure.Among 116 patients,107 were diagnosed with groin hernia by operation,and 9 were found no hernia during operation.In 130 patients with normal ultrasonographic performance,6 patients underwent surgical exploration due to aggravated groin pain,confirming groin hernia in 5 patients and lymph node enlargement in 1;and the remaining 124 patients received no surgical treatment during follow-up survey.Based on the operation findings,the sensitivity,specificity and accuracy of ultrasonography were 95.5%,10%,and 88.5%,respectively.Conclusion Ultrasonography is effective for diagnosing some occult groin hernias,but its false negative is high.Those with normal ultrasonographic performance should be considered for further investigation,and surgical exploration should be performed when necessary.

关 键 词：腹股沟疝 隐匿性 超声 灵敏度 特异度 

分 类 号：R656.21[医药卫生—外科学]