MSCT在诊断成人嵌顿性腹外疝中的价值

发布时间：2018-03-10 08:04

本文选题：嵌顿疝　切入点：腹股沟斜疝　出处：《皖南医学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的:研究容易引起成人腹外疝嵌顿的腹股沟斜疝、股疝和闭孔疝的急诊腹部多层螺旋CT(multislicle computed tomography,MSCT)平扫的影像学表现,探讨是否能够通过腹股斜沟疝、股疝和闭孔疝在MSCT影像学的表现来对患者做出准确的诊断与鉴别诊断,尤其是对隐匿性疝和复合疝患者。方法:搜集笔者所在医院科室自2013年4月至2014年2月期间急诊收治的30例嵌顿性腹外疝,全部患者均经急诊手术明确具体嵌顿疝的类型。回顾性分析患者术前的MSCT影像学表现特点,重点观察嵌顿疝的位置、形态、走行、内容物及与周围结构间的关系以及继发征象。结果:MSCT术前诊断出嵌顿性腹股沟斜疝18例,股疝9例,闭孔疝3例,与术中所证实的疝类型完全相符。其中18腹股沟斜疝患者中均显示腹股沟管有扩张,12例有腹股沟深环的明显扩大。辅以Delabrousse E的“十”字交叉法为参考,18例斜疝疝囊均位于内上象限,其中有3例患者的疝囊较大同时占据了外上象限,9例股疝疝囊均位于外下象限,9例股疝中2例显示股静脉受疝囊压迫变形,2例因疝外被盖组织的水肿而占据少许外上象限,经统计学分析用Delabrousse E的“十”字交叉法来鉴别嵌顿性斜疝和股疝有统计学差异(x~2=21.6,P0.01)。同时经手术证实的3例闭孔疝患者亦完全符合术前MSCT的影像学诊断。结论:MSCT能够显示腹股斜沟疝、股疝和闭孔疝的位置、形态、走行、内容物以及与周围结构之间的关系。采用Delabrousse E的“十”字交叉法能够为嵌顿的腹股斜沟疝、股疝的诊断与鉴别诊断提供有价值的信息,特别是针对隐匿性疝患者如:疝囊偏小或肠管壁疝(Richter疝)等;而且MSCT目前已成为闭孔疝影像学诊断的“金标准”。
[Abstract]:Objective: to study the imaging features of indirect inguinal hernia, femoral hernia and obturator hernia in emergency abdominal multilayer spiral CT(multislicle computed tomographic MSCT (MSCT), and to investigate whether the hernia can be passed through the oblique inguinal hernia. Femoral hernia and obturator hernia in MSCT imaging findings to make an accurate diagnosis and differential diagnosis. Methods: 30 cases of incarcerated external hernia were collected from the department of our hospital from April 2013 to February 2014. The types of incarcerated hernia in all patients were determined by emergency operation. The MSCT imaging features of the patients before operation were analyzed retrospectively, and the location, shape and course of incarcerated hernia were observed. Results 18 cases of incarcerated indirect inguinal hernia, 9 cases of femoral hernia and 3 cases of obturator hernia were diagnosed before the operation. All of 18 patients with indirect inguinal hernia showed dilatation of inguinal canal and obvious enlargement of deep inguinal ring in 12 cases. Delabrousse E's "X" crossing method was used as a reference for 18 cases of indirect hernia. The sacs are located in the inner upper quadrant, Of the 9 cases of femoral hernia, 2 cases showed that the femoral vein was compressed and deformed by hernia sac. 2 cases occupied a little of the superior quadrant due to edema of the outer tegmental tissue of hernia. There was statistical difference in distinguishing incarcerated oblique hernia from femoral hernia by "ten" cross method of Delabrousse E. At the same time, 3 cases of obturator hernia proved by operation were also fully consistent with the imaging diagnosis of preoperative MSCT. Conclusion: 1% MSCT can distinguish incarcerated oblique hernia from femoral hernia. Showing inguinal hernia, The position, shape, movement, contents and relationship with surrounding structures of femoral hernia and obturator hernia can provide valuable information for the diagnosis and differential diagnosis of incarcerated oblique inguinal hernia. Especially for patients with occult hernia, such as small hernia sac or Richter hernia of intestinal wall, MSCT has become the golden standard for imaging diagnosis of obturator hernia.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R656.2

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