MSCT多平面重建技术在腹内疝诊断及分型中的临床价值

MSCT and multiplanar reconstruction in diagnosis and classification of intraabdominal hernia

目的探讨MSCT多平面重建(MPR)技术在腹内疝诊断及分型中的临床应用价值。方法回顾性分析2010年8月至2014年12月,扬州市第一人民医院经手术或随访证实的27例腹内疝患者的横轴面CT及MPR表现,观察肠管异位分布及其占位效应,肠梗阻及其肠壁、系膜缺血征象,梗阻肠袢与邻近肠管、系膜的关系等。结果肠黏连束带疝13例,右侧十二指肠旁疝3例,盆腔内疝3例,盲肠周围疝3例,乙状结肠周围疝2例,小肠系膜疝1例,左结肠系膜裂孔疝1例,吻合口后方疝1例。疝内容物均为小肠及其系膜,疝入小肠袢呈肿块状、囊袋状、簇状。闭袢性小肠梗阻18例,小肠壁水肿增厚9例,其中小肠坏死5例,小肠穿孔1例;近端小肠梗阻15例;肠系膜静脉增粗、聚集,向疝口部位集中形成"缆绳征"17例。15例CT随访检查中7例闭袢性小肠梗阻或近端小肠梗阻加重,4例减轻,4例无明显变化。结论 MSCT多平面重建技术能较准确地诊断腹内疝,为手术治疗提供了可靠依据,可作为腹内疝诊断及分型的首选影像检查手段。

Objective To explore the clinical value of multi-slice spiral CT（ MSCT） and multiplanar reconstruction（ MPR） in diagnosis and classification of intraabdominal hernia. Methods A total of 27 cases of intraabdominal hernia confirmed surgically or by follow-up between August 2010 and December 2014,were retrospectively analyzed with axial CT and MPR. The intestinal heterotopic distribution and its space occupying effect,signs of intestinal obstruction and intestinal wall / mesentery ischemia,and the relationship between intestinal loop and adjacent bowel / mesentery were observed. Results There were13 cases of adhesive band hernia,3 cases of right paraduodenal hernia,3 cases of pelvic hernia,3 cases of pericecal hernia,2 cases of sigmoid colon around hernia,1 case of intestinal mesenteric hernia,1 case of left mesocolon hiatal hernia and 1 case of anastomotic posterior hernia. The contents of hernia were small bowels and its mesentery. Intestinal loop herniated presented as mass,bag shaped or cluster. There were18 cases of closed loop obstruction. The walls of small bowels thickened with edema in 9 cases,including5 cases of intestinal necrosis and 1 case of intestinal perforation. There were 15 cases of proximal small bowel obstruction. The mesenteric vein thickened in 17 cases,concentrated to the hernia orifice parts and showed＂cable＂sign. There were 15 cases with CT follow-up examination： closed loop obstruction or proximal small bowel obstruction became heavier in 7 cases,relieved in 4 cases and no obvious change in 4 cases.Conclusion MSCT and multiplanar reconstruction can accurately diagnose intraabdominal hernia and provide a reliable basis for surgery,which can be used as the first choice of examination methods in diagnosis and classification of intraabdominal hernia.