腹内疝MSCT典型征象探讨

The clinical study of diagnosis criteria for internal abdominal hernia with multiple-slice spiral CT

目的探讨腹内疝的螺旋CT的典型征象。方法回顾性分析经手术证实的23例腹内疝患者的CT资料,23例中8例行CT增强扫描。对不同腹内疝的典型征象与手术病理对照进行分析。结果粘连束带疝12例,屈氏韧带疝1例、屈氏韧带肝胃韧带缺口疝1例、镰状韧带疝1例、小网膜囊疝1例、肠系膜裂口疝3例、左膀胱上疝4例。腹内疝特征性CT表现为肠管形态异常、肠管聚集、移位,肠管换位征、肠系膜血管移位;多平面重建CT图像显示“囊袋征”、“成束气球征”、“涡轮征”、“凹脐征”、“假肾征”,疝口处肠管狭窄呈鸟嘴状改变。23例中18例经手术病理证实合并肠绞窄。结论多排螺旋CT多平面重组对腹内疝的诊断及肠绞窄的评定具有重要的临床价值。

Objective To explore the clinical criteria for internal abdominal hernia with multiple-slice spiral CT.Methods 23 cases of internal abdominal hernia proved by operation were retrospectively analyzed by Multi-planner reforrnation(MPR).Among them,8 patients underwent enhanced CT scanning.The MSCT imaging features of the type of internal hernia were analyzed comparatively with the pathological results during operation.Results 23 cases of internal abdominal hernia included 12 cases of ankylenteron strap hernias,1 case of Treitz’s hernia,1 case of hernia of gap between Treitz and ligamentum hepatogastricum,1 case of falciform ligament of liver hernia,1 case of foraminal of winslow hernia,3 cases of mesenteric hiatal hernias,and 4 case of superior vesical hernia.The typical characteristics of CT images were the abnormal intestinal morphology and intestinal accumulation,translocation,transposition of intestinal tube,and mesenteric vascular shift.Multi planar reconstruction CT showed bag sign,balloon sign,turbo sign,concave umbilical sign,and renal sign.Orificium hernialis was shown as beak sign.Conclusion The MSCT with multi-planner method has important value in diagnosing and clinical treatment of internal hernia,main CT signs as well as grading of intra-abdominal hernia with MSCT for guiding the suigical programs.