16排螺旋CT在腹股沟斜疝和股疝鉴别诊断中的价值研究

Value of 16-slice Spiral CT in Differential Diagnosis of Oblique Inguinal Hernia and Femoral Hernia

目的探讨16排螺旋CT在腹股沟斜疝和股疝鉴别诊断中的价值。方法回顾性分析2016年1月-2018年1月我院收治的112例经手术证实的腹股沟斜疝和股疝患者的临床资料。所有患者均于术前行盆腔CT检查,分析16排螺旋CT鉴别诊断腹股沟斜疝和股疝的准确性,观察疝的位置、走行、形态、内容物、与周围结构的解剖关系等影像学特征。结果 16排螺旋CT鉴别诊断腹股沟斜疝和股疝的灵敏度为92.13%(82/89),特异度为90.63%(29/32),准确率为91.74%(111/121)。73例腹股沟斜疝患者存在腹股沟管扩大征象61例(83.56%),腹股沟管深环不同程度扩大46例(63.01%),轴位、冠状位见82个疝囊位于精索或子宫圆韧带前侧52个(63.41%),前内侧30个(36.59%),矢状位见疝囊源于腹壁下动脉外侧,腹股沟管位于腹股沟韧带前方。股疝患者轴位可见疝囊起源于腹壁下动脉内下方,位于股静脉内侧或前内侧,疝内容物位于耻骨结节后外象限,冠状位可见疝囊位于"影像学股三角"内,矢状位可见疝囊位于腹股沟韧带后下方。结论腹股沟斜疝和股疝在16排螺旋CT检查中有特征性的图像表现,CT鉴别诊断腹股沟斜疝和股疝的准确性较高。

Objective To explore the value of 16-slice spiral CT in differential diagnosis of oblique inguinal hernia and femoral hernia.Methods The clinical data of 112 patients with oblique inguinal hernia and femoral hernia confirmed by surgery were admitted to our hospital between January 2016 and January 2018 were analyzed retrospectively.All patients were given pelvic CT examination before operation,and the accuracy of 16-slice spiral CT was analyzed in the differential diagnosis of oblique inguinal hernia and femoral hernia,and the imaging features of location,line feed,morphology,contents,and the anatomical relationship with the surrounding structures of hernia were observed.ResultsThe sensitivity,specificity and accuracy rate of 16-slice spiral CT were 92.13%(82/89),90.63%(29/32)and 91.74%(111/121)in the differential diagnosis of oblique inguinal hernia and femoral hernia.Among 73 cases of patients with oblique inguinal hernia,there were 61 cases(83.56%)with enlarged inguinal canal and 46 cases(63.01%)with different degree enlargement of deep inguinal ring,82 hernial sacs in the axial position and coronal position showed 52(63.41%)in anterior side of spermatic cord or uterine round ligament and 30(36.59%)in the anterior medial side,and the sagittal position showed that the hernia sacs were originated from the lateral side of the inferior epigastric artery,and the inguinal canal was located in front of inguinal ligament.The axial position of patients with femoral hernia showed the hernia sacs were originated in the inferior part of inferior epigastric artery and was located in the medial or anterior medial femoral vein,and the contents were located in the external quadrant of the tuberculum pubicum,and the coronal position showed that the hernia sacs were located within"the imaging femoral triangle",and the sagittal position showed that the hernia sacs were located in posterior inguinal ligament.Conclusion Oblique inguinal hernia and femoral hernia have characteristic images performance in 16-slice spiral CT examination,and CT has high accuracy in differential diagnosis of oblique inguinal hernia and femoral hernia.