膈疝的临床及影像学分析

Clinic and imageologic analysis of diaphragmatic hernia

目的:加深对膈疝的临床及影像征象的认识并对检查方法进行比较。方法:回顾性分析14例经手术证实的膈疝的影像表现。结果:膈疝具有下列征象:①膈面异常:膈面轮廓部分或全部不清与缺如;假膈面升高;膈上半圆形块状阴影;②胸腔积气积液阴影或块状影:中下肺野囊状或蜂窝状透光阴影;胸腔宽大气液平面;心膈角区肿块影;③胸腔阴影形态的可变性:不同时间、不同体位阴影形态、数量或密度发生改变;④邻近脏器的异常:纵隔向健侧移位;腹部正常脏器的向上移位;⑤钡餐及钡灌肠检查胸腔内见胃肠道影;⑥CT扫描胸腔内见胃肠道、网膜及肠系膜、肝脾肾。结论:影像学检查对膈疝的术前诊断有重要价值。胸腹部平片及透视对膈疝有提示作用,钡餐(钡灌肠)能直接显示胸腔内胃肠道,胸腹部CT扫描能显示疝入胸腔的空腔脏器或实质性脏器。

Objeetive：Strenghthen the clinic and imageology sign of the diaphragmatic hernia and evaluated various diagnostic methods. Methods：The imageelogy signs of 14 cases with diaphragmatic hernia confirmed by surgical operation were reviewed. Results：See the following signs： ① The unusual diaphragm： diaphragm outline partly or completely unclear and scarce; The rise of the false diaphragm; Semi-circular cubic shade on the diaphragm; ② The thorax accumulating gas and liquid shadow or agglomeration shadow： mid-lower half lung or alveolate shadow; Big gas-liquid interface in thorax; Mass shadow in heart diaphragm angle; ③ Changeablility of the hemia in thorax： different shape, quantity or density in different time and body posture; ④Internal organs are unusual： the mediastinum shifts to- wards the nonnal side; The internal organs of the belly shift up; ⑤ Barium meal and barium enema exmination can see gastrointestinal tract in thorax; ⑥ CT thorax scans can see stomach and intestines, network membrane and mescnterlum, liver, spleen, kidney in the thorax. Conclusion： Imageology exmination is necessary to the diaphragmatic hernia diagnosis before surgical therapy. Plain film of chest or belly and perspective examination can hint disphragmatio hernia, the barium meal （barium enema） can show the stomach and intestines in the thorax directly, and chest and abelominal CT waning can show especially parenchymatous organ in thorax.