摘要
目的 分析闭孔疝合并肠梗阻的 多层螺旋CT表现及多层螺旋CT诊断价值。 方法 以我院2012年1月-2015年6月经手术 病理证实的15例闭孔疝合并肠梗阻患者为 研究对象,对其术前多层螺旋CT(MSCT) 影像学表现进行回顾性分析。结果 术前 MSCT检查提示小肠梗阻,表现为小肠扩张 积气,直径3cm以上;梗阻区域表现出典 型鸟嘴征,闭膜管区疝囊颈小结节状,疝 囊于闭孔外肌与耻骨肌间嵌顿;小肠缺血 坏死8例,CT上表现出小肠肠壁增厚且水 肿,肠系膜脂肪间隙模糊,伴少量腹水, 穿孔4例,表现为腹腔内少量游离气体可 见。结论 闭孔疝合并肠梗阻MSCT影像特 征典型,其鸟嘴状等直接征象能明显提高 疾病术前诊断准确率,为手术提供重要影 像依据。
Objective To analyze the findings and diagnostic value of multi-slice spiral CT in obturator hernia with intestinal obstruction. Methods 15 cases of patients with obturator hernia and intestinal obstruction surgically and pathologically confirmed in our hospital from January 2012 to June 2015 were taken as the research objects. The imaging findings of preoperative multi-slice spiral CT (MSCT) were retrospectively analyzed. Results Preoperative MSCT examination showed small intestine obstruction, which manifested as expansion and pneumatosis of small intestine, 3cm or longer in diameter; Obstruction regions showed a typical beak sign, nodular hernia sac neck in obturator canal region, incarceration of hernial sac between external obturator muscle and pectineus; There were 8 cases of small intestinal ischemia and necrosis, showing samll intestinal wall thickening and edema on CT, fuzzy mesenteric fat clearance, with a small amount of ascites. There were 4 cases of perforation, showing visible small amount of free gas in the abdominal cavity. Conclusion The MSCT characteristics of obturator hernia with intestinal obstruction are typical. Its beak like and other direct signs can obviously omprove the preoperative diagnostic accuracy of the disease and provide important imaging evidence for the operation.
【关键词】闭孔疝;肠梗阻;多层螺旋 CT;影像表现
【中图分类号】R445.3
【文献标识码】A
【DOI】 10.3969/j.issn.1672- 5131.2016.02.036
前言
闭孔疝在临床腹外疝中比较少见,通常其发病率不足1.5%,但 闭孔疝病死率较高,约10%~50%[1]。闭孔疝发病一般以肠梗阻症状为 主,受其发病位置及结构特殊性影响,临床症状及体征不典型,术前 确诊难度相对大,通常需经由剖腹探查术确诊,延误治疗时间,加重 病情,易引发嵌顿性小肠梗阻,是导致患者死亡的主要原因之一[2]。 为此术前早期诊断疾病,及时手术对降低相关并发症及病死率具有十 分重要的意义。近年来多层螺旋CT(MSCT)因其直观性强、后处理功能 强大、分辨率高等特点在闭孔疝、肠梗阻诊断中应用较多,能明显 提高术前疾病诊断准确率。基于此,本研究回顾性分析我院2013年1 月~2015年6月手术病理证实15例闭孔疝合并肠梗阻患者MSCT影像资 料,报告如下。
中国CT和MRI杂志
第14卷, 第 2 期
2016年02月
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