膈疝的影像学表现与检查方法

目的加强对膈疝的临床X线和CT征象的认识及影像检查方法的选择。方法回顾性分析17例经手术或临床胃镜证实的膈疝患者的影像学征象,并与手术结果对照。结果 6例不可复性食管裂孔疝在胸片上分别显示左侧膈肌抬高,膈上方见含气液平面的软组织肿块或纵隔及心影后含气液平面囊腔影;2例胸腹膜裂孔疝显示左侧胸腔内蜂窝状透亮影,与膈肌境界不清;2例胸骨旁裂孔疝显示左侧膈肌明显抬高,其上方可见气液平面。11例钡餐及2例钡灌肠均显示部分胃、小肠或结肠疝入胸腔内。CT检查13例中,11例食管裂孔疝,疝囊均经过膈肌食管裂孔疝入胸腔。11例食管裂孔疝中6例胃底部经食管裂孔疝入胸腔,1例大网膜经食管裂孔疝入胸腔,4例外伤性膈疝。5例超声检查中3例探及胸腔内无回声区,且动态观察短时间内变化较大。结论钡餐（泛影葡胺）或胸部上腹部CT扫描对膈疝的诊断及术前定位有重要价值,胸片及超声检查可作为发现病变及鉴别诊断病变的影像学检查方法。

Imaging manifestations and inspection methods of diaphragmatic hernia

Objective To evaluate the understanding of the clinical X-ray and CT signs of diaphragmatic hernia and the selection of imaging inspection methods.Methods The imaging signs of 17 patients diagnosed with diaphragmatic hernia by surgery or clinical gastroscopy were analyzed retrospectively and compared to the surgical results. Results The chest films of 6 patients with irreducible esophageal hiatal hernia displayed left diaphragmatic elevation,soft tissue mass containing liquid surface above the diaphragm or cyst shadow containing liquid surface behind the mediastinum and heart shadow.The chest films of 2 patients with pleuroperitoneal hiatal hernia displayed left thoracic cellular transparent shadow and unclear diaphragmatic realm.The chest films of 2 patients with parasternal hiatal hernia displayed obvious left diaphragmatic elevation and liquid surface above it.All the 11 patients receiving barium meal and 2 pa - tients receiving barium enema showed that part of the stomach,small intestine or colon herniated into the chest cavity. Of the 11 patients with esophageal hiatal hernia,6 patients showed that the bottom of the stomach herniated into the chest cavity through the esophageal hiatal hernia,1 patient showed that the omentum majus herniated into the chest cavity through the esophageal hiatal hernia,and 4 patients showed traumatic diaphragmatic hernia.Of the 5 patients receiving ultrasound,3 patients had no echo zone in the chest cavity and the changes within a short time were larger under dynamic observation.Conclusion Barium meal （meglumine diatrizoate） or chest and upper abdominal CT scan has important value for the diagnosis and preoperative location of diaphragmatic hernia.Chest X-ray and ultrasound detection are used for disease detection and differential diagnosis.