腹腔内疝的多排螺旋CT诊断

Application of Multi-detector Row Spiral Computed Tomography in Diagnosis of Internal Hernia

目的:分析腹腔内疝的多排螺旋CT(Multi-detector row spiral CT,MDCT)影像学表现,探讨MDCT对诊断腹腔内疝的价值。方法:收集2007-2015年间我科术前行MDCT检查且经手术证实的腹腔内疝病人8例(左侧十二指肠旁疝2例,经肠系膜疝5例,子宫阔韧带疝1例)。分析腹腔腹腔内疝的MDCT表现和特征。结果:左侧十二指肠旁疝主要表现为呈包块样聚集的肠袢位于胃胰之间,屈氏韧带的左方,推压胃后壁前移。经肠系膜疝表现为聚集的小肠袢紧贴腹前壁,和腹壁之间无大网膜覆盖。子宫阔韧带疝表现为子宫侧旁聚集的扩张小肠袢,其积液扩张及近侧小肠梗阻表现。疝的共同MDCT征象包括:肿块状或者簇状异聚集的小肠袢;周围脏器或肠管的移位;肠梗阻的征象;肠系膜血管的改变(牵拉,移位,扭曲及充血等)。结论:腹腔内疝的MDCT表现具有一定的特征性,对于术前准确诊断有较高的价值。

Objective： To explore the value of multi-detector row spiral computed tomography （MDCT） in diagnosis of internal hernia by analyzing the imaging findings of patients with internal hernia. Methods： From year 2007 to 2015, eight patients with internal hernias （two cases of left paraduodenal hernia, five cases of transmesenteric hernia, and one cases of hernia of the broad ligament of the uterus） underwent MDCT examination before operation and confirmed after operation in our hospital were collected and the MDCT find- ings and characteristics of internal hernia were analyzed. Results： The left paraduodenal hernia mainly presented as encapsulated cluster of dilated intestinal loops, which located between stomach and pancreas and left of the Treitz ligament, and displaced the posterior gastric wall anteriorly. The transmesenteric hernia showed as encapsulated cluster of intestinal loops directly abutting anterior abdominal wall without omentum covering. The hernia of the broad ligament of the uterus displayed as a cluster of dilated small intestine loops located lateral of uterus. The Common MDCT findings of internal hernias included mass-like or cluster aggregation loops of small intestine; dis- placing of adjacent organs or intestinal; signs of bowel obstruction; mesenteric vessels changes （stretched, displaced, distorted and con- gestion, etc.）. Conclusion： The certain MDCT features of abdominal internal hernia may help accurate diagnosis before operation.