食管裂孔疝的多层螺旋CT表现(附140例国人正常食管裂孔宽径的测量结果)

The multislice spiral CT findings of esophageal hiatus hernia(enclosed the normal esophageal hiatus diameter in 140 Chinese)

目的评价 CT 测量食管裂孔宽度的临床意义并认识食管裂孔疝(EHH)在多层螺旋CT(MSCT)上的表现。方法(1)在140例成人的胸、腹部正常 MSCT 图像上,测量了代表食管裂孔宽度的膈肌脚间距,并作统计学分析;(2)搜集56例经上消化道造影或胃镜诊断为食管裂孔疝的胸、腹部 MSCT 资料,测量了患者的膈肌脚间距,并回顾性分析了食管裂孔疝的 CT 表现。结果 (1)140例成人正常膈肌脚间距平均值为(13.44±4.41)mm,并且随年龄增加而增大,其中≤59岁(80例)和≥60岁(60例)者膈肌脚间距平均值分别为(11.03±2.10)mm 和(16.67±4.64)mm,两者间的差异有统计学意义(t=8.762,P<0.01)。成人正常膈肌脚间距的上界为21 mm。(2)56例 EHH的膈肌脚间距测量平均值为(29.50±9.71)mm,与正常膈肌脚间距之间的差异有统计学意义(t=21.684,P<0.01),83.93%(47例)EHH 的膈肌脚间距均较正常上界为大。(3)56例 EHH 在 CT 上都表现为经食管裂孔进入后纵隔心后区内的假肿块或假结节影,其中53例(94.6%)为胃肠型,3例(5.4%)为非胃肠型。胃肠型者中,37例(69.8%)呈假肿块状影,大小16 mm×31 mm～88 mm×110 mm,16例(30.2%)呈直径<30 mm的假结节状软组织影。92.4% EHH 的疝囊内含有气体和(或)对比剂或液气平面,增强时疝囊壁与膈下胃壁一致强化。结论食管裂孔增大是发生 EHH 的前提和主要原因,在 EHH 的 CT 诊断上有重要意义。CT 还能从多方面显示 EHH 的全貌,有助于鉴别诊断及避免将 EHH 误诊为食管或胃的其他病变。

Objective To evaluate the clinical significance of the diameter of the esophageal hiatus on multislice spiral CT （MSCT） and to present the MSCT manifestations of esophageal hiatus hernia （EHH）. Methods （1）The distance between diaphragmatic erura（DDC）, which indicated the diameter of esophageal hiatus, was measured in 140 normal adult patients on their thoracic and/or abdomenal CT images. （2）The DDC of 56 patients with EHH diagnosed by barium examination was measured on MSCT, and the MSCT findings were analyzed retrospectively. Results （ 1 ） The DDC of 140 normal adult cases were （13.44±4.41 ）ram on average and increased with age. The mean DDCs of patients under the age of 59 year-old （80 eases） and over 60-year-old （60 cases） were 11.03 ± 2. 10 mm and 16. 67 ± 4. 64 mm respectively, there was a significant difference （ t = 8. 762, P 〈 0. 01 ）. The longest DDC was 21 mm in normal patients. （2）The mean DDC in 56 EHH cases was 29. 50 ± 9.71 mm and was longer than that of normal patients （t = 21. 684, P 〈0. 01 ）. The DDCs in 83.93% （47 cases） EHH patients were longer than 21 mm （3） Of 56 EHH cases, 53 cases （94. 6% ） were gastrointestinal type and only 3 cases （5.4%） were nongastrointestinal type. On MSCT images, EHH manifested as a pseudomass or pseudonodule located in posterior mediastinum through the esophageal hiatus. In gastrointestinal type, 37 cases （69. 8% ） presented as pseudomasses with the size from 31 mm to 110 mm, 16 cases （30. 2% ） presented as psedunodules with the size 〈 30 mm. Gas, contrast medium or gas-fluid level were found in 92. 4% cases. The wall of EHH showed the same enhancement with the gastric wall. In 3 cases of nongastrointestinal type, the content of EHH was ascites in one case and omental fat in two cases. Conclusions The widening of esophageal hiatus is the main cause of EHH and is very important for the CT diagnosis of EHH. MSCT is helpful for the differential diaanosis of EHH.