腹内疝病理基础及分型的多层螺旋CT诊断探讨

目的:探讨腹内疝多层螺旋CT(MSCT)表现的病理基础及分型,扩大影像学诊断本病的应用范围。方法:回顾性分析经手术证实的18例腹内疝的MSCT表现。结果:18例术前MSCT均表现为小肠梗阻,7例发生肠管绞窄。11例诊断为腹内疝,包括十二指肠旁疝3例,网膜孔疝1例,盲肠周围疝1例,肠粘连束带疝6例。术后证实18例均有小肠梗阻,其中,十二指肠旁疝4例,网膜孔疝1例,肠系膜裂孔疝1例,大网膜裂孔疝1例,盲肠周围疝1例,术后形成腹内疝有肠粘连束带疝9例,胃切除术吻合口后疝1例。闭襻性肠梗阻和肠系膜及其血管的绞窄是腹内疝的病理基础,也构成了CT诊断的共性征象,腹内疝的解剖分型则是CT诊断的个性特征。结论:肠粘连束带疝将成为腹内疝分类中新的分型,MSCT能较准确诊断腹内疝,为临床治疗提供可靠证据。

A study of pathological basis and type of multi-slice spiral CT features in diagnosing intra-abdominal hernia

Objective： To study the pathological basis and type of multi-slice spiral CT （MSCT） features in diagnosing intra-abdominal hernia.and extend application range of imaging for this disorder. Methods：The MSCT findings of 18 patients with intraabdominal hernia confirmed at surgery were retrospectively analysed. Results： All of 18 cases were diagnosed as intestinal oh struetion by MSCT. CT showed intestinal strangulation in 7 eases, intraabdominal hernia in 11 cases, including 3 cases of paraduodenal hernia, 1 case of foramen of Winslow hernia, 1 case of pericecal hernia and 6 cases of secondary adhesion by postopcration. It was confirmed by post operation that all 18 cases suffered small bowel obstruction,including 4 cases of paraduodenal hernia,1 case of foramen of Winslow hernia, 1 cases of transmesenterlc hernia, 1 cases of transomental hernia, 1 case o{ pericecal hernia,and 9 cases of adhesive band hernia,the last one was post-gastrotomy stomal hernia. The pathological basis of intra ahdominal hernia including obstruction of closed loops,strangulation of mesenterium and its vessels, forming common features in CT diagnosis,and the type of it according to anatomic characters forms individual features in CT diagnosis. Conclusion： Adhesive band hernia will become a new type of intra abdominal hernia,MSCT can do well in diagnosis of intra-abdominal hernia and provide reliable evidence for clinical treatment.