高频超声对白线疝的诊断价值

目的探讨高频超声在诊断白线疝中的应用价值。方法回顾性分析16例经手术病理证实为白线疝的高频超声声像图表现。结果16例患者术前全部行高频超声检查。瘤体均位于腹正中线附近的腹壁上,呈圆形或椭圆形的实性中等回声、中高回声或肠道混杂性回声,直径1.2～8.1cm。结论高频超声可直接地显示白线疝的内部结构、大小、形态、回声及血供情况,为临床分型及鉴别诊断提供重要依据,可作为白线疝的首选影像学检查方法。     

白线疝的高频彩色多普勒超声诊断价值

【目的】探讨高频彩色多普勒超声对白线疝的诊断价值。【方法】回顾性分析16例经手术证实的白线疝高频彩色多普勒超声特征。【结果】本组所有疝囊均位于脐上,高频超声可以清晰显示白线部位疝孔的位置和大小[(1.52±0.8)cm]、疝内容物大小及囊壁的有无,疝内容物表现为腹膜外脂肪低回声(4/16)、网膜高回声(10/16)或伴有肠管回声(2/16),彩色多普勒显示(11/16)的疝颈内有血流信号。【结论】高频彩色多普勒超声可以对白线疝准确诊断,判断疝内容物,并显示疝入血流信号,对临床手术治疗提供有价值的信息。     

高频超声对腹外疝的诊断价值

目的:探讨高频超声对腹外疝的临床诊断价值.方法:对96例经手术证实的腹外疝的高频超声声像图特点进行回顾性分析.结果:本组96例腹外疝中,腹股沟斜疝83例,直疝5例,脐疝3例,切口疝、白线疝各2例,股疝1例,其中11例(斜疝嵌顿10例,股疝嵌顿1例)诊断为嵌顿疝,2例诊断为绞窄性腹股沟斜疝.疝内容物为肠管68例,大网膜28例;3例嵌顿疝发生肠坏死.结论:高频超声检查腹外疝可清晰显示疝囊及其内容物,并能对可复性疝与嵌顿性疝作出鉴别,有很高的临床实用价值.     

超声对白线疝的诊断价值

目的 分析白线疝的超声表现特点,评价超声诊断白线疝的临床应用价值.方法 临床拟诊为白线疝的患者28例,术前均行腹壁超声检查,并与术中所见及病理结果进行对比分析.结果 与病理结果比较,术前超声诊断白线疝15例,误诊3例,漏诊5例,正确排除白线疝5例.15例白线疝患者均为可复性疝,腹白线缺损0.5～4.5 cm,腹压改变时可见疝内容物通过缺损处往返移动.与手术病理结果比较,超声检查白线疝敏感性75.0％,特异性62.5％,误诊率37.5％,漏诊率25.0％,准确率71.4％,阳性预测值83.3％,阴性预测值50.0％,阳性似然比2.0,阴性似然比0.4,尤登指数0.375.结论 腹壁包块穿越白线并可见白线缺损是超声诊断白线疝的重要依据.对于小的白线疝,应以白线为参照,仔细观察腹壁包块与白线的解剖关系,以提高诊断准确率.     

超声诊断女婴腹股沟卵巢嵌顿疝的价值

目的探讨超声对疝内容物包含卵巢的女婴腹股沟嵌顿疝的诊断价值。方法分析25例经手术证实的疝内容物包含卵巢的女婴腹股沟嵌顿疝的超声表现。结果24例患者腹股沟区均探及典型卵巢回声,诊断符合率96％;1例患儿腹股沟区探及肠管回声,而手术所示疝内容物为小肠、左侧卵巢及输卯管：其中2例嵌顿卵巢内未探及彩色血流信号,手术发现卵巢已坏死。结论超声能清晰检出腹股沟区嵌顿的卵巢回声,是诊断卵巢嵌顿疝的有效方法,且可探及疝内容物的彩色血流信号,对卵巢嵌顿性疝的预后评估有重要价值：     

新生儿腹股沟嵌顿性斜疝的彩色多普勒超声诊断价值

目的分析新生儿腹股沟嵌顿性斜疝的声像图特征,评价彩色多普勒超声诊断价值。方法对11例新生儿腹股沟嵌顿性斜疝行超声检查,观察疝块的各项指标,包括大小、内部回声、形态及周边情况等,并用CDFI观察疝内容物的血流信号。结果新生儿腹股沟嵌顿性斜疝声像图多表现为阴囊内肿块,疝囊内容物以肠袢最为常见,超声可显示增厚的肠壁及肠腔内无回声区(积液)。CDFI:疝内容物血流信号较少。结论彩色多普勒超声能清晰地检出新生儿嵌顿性斜疝,是有效的诊断方法,对嵌顿性斜疝的诊断、鉴别诊断及预后评估有重要价值。     

高频超声在腹壁切口疝修补术前后的应用价值

目的探讨超声对切口疝修补术前后检查的应用价值。方法应用超声对38例切口疝修补手术前后患者进行检查。结果38例术前全部显示切口疝疝环的大小及位置,疝囊大小、位置及内容物。术后全部显示补片的位置、形态和大小,其中30例未见明显异常。7例提示补片外液性暗区,1例为补片外混合性高回声团。结论超声能够为医生选择补片种类及大小提供依据。术后能清晰的显示补片的位置、形态及相邻关系,有无并发症。     

高频彩超在白线疝诊断中的临床价值

目的探讨高频超声及彩色多普勒血流显像对白线疝的诊断价值。方法运用高频超声及彩色多普勒血流显像技术并结合乏氏动作对32例白线疝患者进行检查。结果32例中超声诊断为可复性疝5例,难复性疝27例;疝内容物为大网膜25例,脂肪组织6例,大网膜和肠管伴有积液1例,与手术及病理结果对照,超声诊断符合率为100%。超声显示上腹部白线部位连续性中断或白线与壁层腹膜连续性中断,断端（疝环）直径〈0.5 cm者6例,0.5-1.0 cm者24例,〉1.1 cm者2例,与手术结果对照,超声诊断符合率为93.7%。结论高频彩超能清晰地显示白线疝的二维图像,结合彩色多普勒血流显像和乏氏动作,能明确诊断疝是否嵌顿及嵌顿的程度,可为临床制定治疗方案提供可靠的依据。     

腹白线疝超声误诊为脂肪瘤1例

患者女,60岁,发现中上腹壁包块20年入院。体格检查：中上腹部脐上正中可见一大小约3 cm×5 cm包块,质中,无压痛,活动可,与周围界限清晰,未触及波动感。超声检查：中上腹皮下脂肪层内探及范围约4.7 cm×2.0 cm的不均质混合性回声,内为中低回声及条状高回声,边界清晰,形态规则（图1）,其内未见明显血流信号。超声提示：中上腹壁皮下不均质混合性回声,考虑脂肪瘤。术中所见：逐层切开皮肤,皮下组织,可见疝囊位于皮下,大小约3cm×5cm,内容物为肝圆韧带,疝环大小约2cm,证实为腹白线疝。     

超声对隐匿性腹股沟疝的诊断价值

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。     

Ultrasound as a diagnostic aid in ventral abdominal hernia

Preliminary results are presented of ultrasound investigations in 34 patients with suspected abdominal hernias. All patients were explored surgically on the basis of clinical indications, and the surgical findings were compared with the results of the ultrasound investigation. Small hernias in the anterior abdominal wall (fascia Spigelii and linea alba) can be demonstrated by ultrasound, but there are certain circumstances which can lead to false positive ultrasound results.     

Measurement of the tensile strength of the ventral abdominal wall in comparison with scar tissue

BACKGROUND: Paramedian laparotomies lead to incisional hernias in approximately 30% of cases. In contrast, incisional hernias occur very rarely in the linea alba or the ventral abdominal wall. In this setting we investigated the difference between scar tissue and the non-incised abdominal wall tissue. METHODS: At the post mortem examination of 66 recently deceased individuals, accurately measured pieces of resected tissue from the linea alba, the anterior and the posterior rectus sheath, and scar tissue following median laparotomy, were exposed to tensile loads. FINDINGS: In the epigastric region the tissue ruptured at a mean horizontal load of 10.0 (SD 3.4) N/mm(2) in the linea alba and 6.9 (SD 2.5) N/mm(2) in scar tissue (P<0.001), and at a mean vertical load of 4.5 (SD 2.0) N/mm(2) in the linea alba and 3.3 (SD 1.6) N/mm(2) in scar tissue (P<0.05). In the hypogastric region as well, scar tissue was significantly less resistant in the main direction of load. INTERPRETATION: Scar tissue has a significantly lesser loading capacity than the intact ventral abdominal wall and therefore poses a permanent risk for herniation. For this reason, closure of the abdominal wall should be given due consideration and subjected to further investigation. Specifically, sustained reinforcement of scar tissue by means of suture techniques or non-absorbable sutures warrants further study. When constructing meshes for reinforcement of incisional hernias, the two-fold tensile load on the midline in horizontal direction as opposed to the craniocaudal direction must be taken into account.     

Access-related complications - an analysis of 6023 consecutive laparoscopic hernia repairs

In order to investigate incidence rates and types of access-related complications that may occur during laparoscopic hernioplasty, we carried out a systematic analysis of our collected results. The aim was to identify risk factors and to develop useful modifications of the surgical technique and the instrumentation used. Since we first introduced laparoscopic hernioplasty in our clinic, we have carried out standardised, prospective documentation of relevant data from all consecutive operations in an electronic database. We performed a systematic analysis of access-related complications and their possible influencing factors, taking into special account the type of instruments used, port-site and prior intra-abdominal operations. Between April 1993 and March 2000, 4857 consecutive patients received a total of 6023 laparoscopic hernia repairs. In 510 patients three-edged, sharp trocars were used and in 4347 patients conical obturators were used to insert the port. The incidence of access-related complications was 0.9% (44/4857) in the total collection (incision hernias 0.5%, bleeding from abdominal-wall vessels 0.2%, bowel injury 0.06%, wound infections 0.06%). Injuries to intra-abdominal or retroperitoneal vessels were not observed. A differentiated analysis of the various trocar types, taking into consideration the number of inserted ports, showed that for incisions outside the linea alba the incidence of bleeding from abdominal-wall vessels was 12 times higher (0.7%, 7/1020 versus 0.06%, 5/8694). The incidence of incision hernias increased significantly (1.2%, 12/1020 versus 0.02%, 2/8694; p = 0.03) when three-edged trocars were used, as opposed to conical obturators. Our results demonstrate that, outside the linea alba, three-edged trocars should no longer be used for portinsertion. The results of our differentiated analysis of laparoscopic hernia repairs, taking into account the type of obturator, the port-site and number of ports inserted, also can be applied to other laparoscopic operations.     

Congenital diaphragmatic hernia: evaluation of prenatal diagnosis in 20 European regions.

OBJECTIVE: To evaluate prenatal diagnosis of congenital diaphragmatic hernia by ultrasound in well-defined European populations. DESIGN: Data from 20 registries of congenital malformations in 12 European countries were included. The prenatal ultrasound screening programs in the countries ranged from no routine screening to three ultrasound investigations per patient being routinely performed. RESULTS: There were 187 cases with congenital diaphragmatic hernia, with an overall prenatal detection rate of 59% (110/187). There was considerable variation in prenatal detection rate between regions. There was a significant difference in the detection rate of isolated congenital diaphragmatic hernia (59/116, 51%) compared with congenital diaphragmatic hernia associated with multiple malformations, karyotype anomalies or syndromes (51/71, 72%) (P = 0.01). Termination of pregnancy was performed in 39 cases (21%) of which 14 cases were isolated congenital diaphragmatic hernia. Mean gestational age at discovery was 24.2 weeks (range, 11-38 weeks). CONCLUSIONS: The overall prenatal detection rate of congenital diaphragmatic hernia is high (59%) but varies significantly between European regions. The gestational age at discovery was greater than 24 weeks in half of the prenatally diagnosed cases.     

Enhancing needle durability by silicone coating of surgical needles

The purpose of this study was to assess the effect of coating surgical needles with silicone on their durability. Needle durability is a measure of needle sharpness after repeated passage through tissue. Needle sharpness was determined by quantitating the energy required to pass a designated needle repeatedly (20 times) through porcine skin, linea alba, colon, and aorta. The results demonstrate that the durability and sharpness of silicone-coated needles were significantly greater than those of comparable uncoated needles in linea alba, colon, and aorta, but not in skin.     

腹壁疝的多层螺旋CT评价

目的评价腹壁疝的多层螺旋CT（MSCT）诊断价值：方法收集182例临床拟诊腹壁疝的患者，经MSCT扫描和多方位重建（MPR），观察和测量疝囊、疝颈及疝内容，并与手术所见对照：结果本组诊断腹壁切口疝143例，自发性白线疝2例，脐疝3例，腹股沟直疝和斜疝12例，腹壁造瘘口疝8例，外伤性腹壁疝14例。疝囊直径小于5cm者86例，在6～10cm者74例，大于10cm者22例。疝内容依据疝颈的部位和大小可为大网膜、肠管甚至临近的器官.结论MSCT可敏感地探测到腹壁疝，并可精确测量疝颈大小，为外科手术修补提供可靠依据.     

腹股沟斜疝与直疝的超声鉴别诊断

目的探讨腹股沟斜疝与直疝的超声鉴别方法及其在腹腔镜疝修补术中的应用价值。方法对我院普外科住院拟行腹腔镜腹股沟疝修补术的106例患者行术前高频超声检查,确认腹壁下动脉与腹股沟疝的关系,凡疝囊自腹壁下动脉外侧、前方通过者诊断为斜疝,而疝囊自腹壁下动脉内侧通过、将其向外前方推挤者诊断为直疝。超声诊断与腹腔镜疝修补术结果比较。结果腹股沟疝患者共106例。其中超声诊断腹股沟斜疝94例,直疝12例,纠正术前临床误诊3例。术前超声诊断明确,106例均经手术证实。结论高频超声能准确鉴别腹股沟斜疝与直疝,有效指导腹腔镜疝修补术。     

超声隐匿性腹股沟疝诊断中影像学特点分析及应用

目的:探讨隐匿性腹股沟疝诊断中超声应用的影像学特点及应用效率分析。方法:纳入本院2019年5月—2020年5月收治的隐匿性腹股沟疝患者79例作为研究对象,分别对其进行超声以及多螺旋CT检查,鉴别诊断其疝内容物,并与患者最终的手术结果对照分析。结果:参与研究的79例患者中,腹股沟斜疝65例,占比82.28%;腹股沟直疝8例,占比10.13%;6例为股疝,占比7.59%,与最终手术结果保持一致;疝内容物:网膜62例,占比79.75%;肠管14例,占比17.72%;2例为合并其他(隐睾、鞘膜积液),占比2.53%,与多螺旋CT检查结果一致。结论:应用超声对隐匿性腹股沟疝进行诊断,诊断符合率较高,基本与手术结果保持一致,同时也可以准确显示疝内容物特征、疝囊等结构,对比临床常规采用手术及螺旋CT检查具有方便、无创、安全、易操作等优势,值得临床应用推广。