不同类型腹股沟疝的高频超声及CDFI特征分析

High-frequency ultrasound and CDFI features of different types of inguinal hernia

目的探究不同类型腹股沟疝患者的超声声像特征,分析高频超声及彩色多普勒血流显像(CDFI)在腹股沟疝诊断中的应用价值。方法选择2017年1月至2019年8月期间万宁市人民医院超声科收治的65例腹股沟疝患者进行回顾性分析。其中,男性55例,女性10例;年龄5~78岁,平均年龄(52.35±8.24)岁。所有患者均于术前行高频超声及CDFI检查,并与手术病理检查对照。结果65例腹股沟疝患者中,直疝5例,易复性疝50例,难复性疝3例,嵌顿性疝5例,绞窄性疝2例。超声声像图显示,直疝患者局部腹壁无明显变化,层次清晰囊内可见少量液性暗区,经CDFI可见少量血流信号;易复性疝、难复性疝患者腹股沟管扩张,内可见肠管、大网膜回声,肠壁层次清晰,无增厚,大网膜网格状囊实性相间杂乱回声或不均匀实性回声,经CDFI可见多个长条状和(或)短棒状的彩色血流信号;嵌顿性疝患者腹股沟、阴囊、大阴唇内可见实性类圆形回声团块,边界清晰,肠壁增厚,回声减低,经CDFI可见血流信号明显减少,团块内可见少许散在的点状血流信号;绞窄性疝患者疝囊内可见渗出的液性暗区,肠壁明显增厚,回声极低,经CDFI可见血流信号急剧减少或消失。以手术病理检查为“金标准”,超声诊断腹股沟疝的灵敏度为96.72%(59/61),特异度为75.00%(3/4),准确率为95.38%(62/65),误诊率为3.08%(2/65),漏诊率为1.54%(1/65);诊断直疝、易复性疝、难复性疝、嵌顿性疝和绞窄性疝的符合率分别为80.00%(4/5)、100%(50/50)、66.67%(2/3)、80.00%(4/5)和100.00%(2/2)。超声测量直疝、易复性疝、难复性疝、嵌顿性疝、绞窄性疝的疝环内径与手术检查比较,差异无统计学意义(χ^2=0.436,1.435,0.878,0.376,0.784;P>0.05)。结论高频超声及CDFI检查对诊断不明确的腹股沟疝患者有重要的临床意义,可作为临床首选检查方法。

Objective To investigate the ultrasonographic features of different types of inguinal hernia,and analyze the value of high-frequency ultrasound and color Doppler flow imaging(CDFI)in diagnosis of inguinal hernia.Methods The study retrospectively reviewed 65 patients with inguinal hernia treated in the Wanning people's hospital from January 2017 to August 2019.Of these,55 were males and 10 were females;they were 5 to 78 years old,with an average age of(52.35±8.24)years old.All patients were subjected to high-frequency ultrasound and CDFI before surgery,and the examination results were compared with surgical pathological results.Results Of 65 patients with inguinal hernia,5 had direct hernia,50 had reducible hernia,3 had irreducible hernia,5 had incarcerated hernia and 2 had strangulated hernia.Ultrasound images showed that there were no obvious changes in local abdominal wall of patients with direct hernia,few liquid dark areas were observed in the sac with clear layers,and CDFI showed few blood flow signals.In patients with reducible hernia and irreducible hernia,inguinal canal dilatation was observed,and intestinal tube and greater omentum echo were observed in the inguinal canal.The layer of intestinal wall was clear,without thickening,and there was greater omentum grid cystic-solid interphase chaotic echoes or uneven solid echoes.CDFI displayed multiple long and(or)short rod-shaped colored blood flow signals.For patients with incarcerated hernia,solid circular echogenic masses were observed in the groin,scrotum,and labia majora,with clear boundaries,thickened intestinal wall,and reduced echo.CDFI showed significantly decreased blood flow signals,and few scattered dotted blood flow signals were observed in the block masses.In patients with strangulated hernia,liquid dark areas in the hernia sac,obviously thickened intestinal wall,and extremely low echoes were observed.CDFI showed that blood flow signals sharply decreased or disappeared.Using surgical pathological results as the golden standard,the sensitivity,specificity,accuracy rate,misdiagnosis rate and missed diagnosis rate of ultrasound for inguinal hernia were 96.72%(59/61),75.00%(3/4),95.38%(62/65),3.08%(2/65)and 1.54%(1/65),respectively.The coincidence rates for diagnosing direct hernia,reducible hernia,irreducible hernia,incarcerated hernia and strangulated hernia were 80.00%(4/5),100%(50/50),66.67%(2/3),80.00%(4/5)and 100.00%(2/2).There was no significant difference in the inner diameter of the hernia ring measured by ultrasound and the value measured during operation(P>0.05).Conclusion Both high-frequency ultrasound and CDFI are of clinical significance in diagnosing ill-defined inguinal hernias,and they can be used as the first choice in clinical practice.