腹股沟疝的多层螺旋CT诊断与鉴别诊断

目的 探讨多层螺旋CT（MSCT）诊断及鉴别诊断腹股沟直疝、斜疝的主要依据.方法 回顾性分析2010年10月—2013年6月中山大学附属第一医院诊断并治疗的54例腹股沟疝患者的临床及MSCT资料.按照确诊的疝类型分为直疝组、斜疝组,对比分析2组患者MSCT影像中疝囊颈位置、腹壁下血管移位情况、新月征、是否进入阴囊等参数.结果 结合临床及MSCT表现,确诊直疝及斜疝各34个.直疝疝囊颈均位于腹壁下血管内侧,41.2％（14/34）腹壁下血管外移,61.8％（21/34）伴新月征,23.5％（8/34）的疝进入阴囊;斜疝中64.7％（22/34）的疝囊进入腹股沟管内口,35.3％ （12/34）腹股沟管显示不清,88.2％（30/34）疝腹壁下血管向内后方移位,均无新月征,64.7％ （22/34）的疝进入阴囊.2组各参数之间的差异均有统计学意义（P值均＜0.05）.结论 MSCT可显示腹股沟区解剖细节,对腹股沟直疝、斜疝的诊断及鉴别诊断具有重要临床意义.

Multi-spiral computed tomography and differential diagnosis of direct and indirect inguinal hernia

Objective To summarize the primary diagnostic and differential diagnostic criteria of direct and indirect inguinal hernia using multiple-spiral computed tomography （MSCT）.Methods Fifyfour inguinal hernia cases diagnosed and treated in the first affiliated hospital of Sun Yat-Sen university from Oct.2010 to Jun.2013 were divided into direct inguinal hernias group and indirect inguinal hernias group,the parameters such as location of hernia necks,inferior epigastric vessels movement,lateral crescent sign,whether hernias entered into scrotum or not were compared between the two groups.Results Thirty-four direct and 34 indirect inguinal hernias were finally diagnosed based on both clinical and MSCT features.In the group of direct inguinal hernia,all hernia necks medial to the inferior epigastric vessels,41.2% （14/34） inferior epigastric vessels moved outwards,61.8% （21/34） with lateral crescent sign and 23.5% （8/34） hernias entered into scrotum.In the group of direct inguinal hernia,64.7% （22/34） hernias entered into the internal inguinal ring and the rest 35.3% （12/34） could not show the ring clearly,88.2% （30/34） inferior epigastric vessels moved to poster medial,no lateral crescent sign and 64.7% （22/34） hernias entered into scrotum.The difference of each parameter between the two groups were statistically significant （all P values 〈 0.05）.Conclusions MSCT can display precisely the anatomical details of inguinal region,which contribute to the diagnosis and differential diagnosis and is very important for clinical strategies.