目的 提高对食管裂孔疝(EHH)的 临床认识并探讨CT对EHH的诊断价值。方 法 回顾性分析2013年7月-2015年4月经上 消化道造影、胃镜等证实的20例EHH的CT 影像特征。结果 本组20例患者中见18例 疝囊及疝内容物位于脊柱左前方，2例位 于脊柱前方或右侧。其中，20例清晰显示 膈上疝囊及“胸腔胃黏膜征”,显示疝入 胸腔之胃体呈“束腰状”改变者14例,疝 囊形态呈现“电缆线征”者2例，口服造 影剂的6例患者及行CT增强扫描的8例患 者CT图像显示经食管裂孔延续于膈下胃 腔的黏膜皱襞，并与膈下胃壁呈均匀一致 性强化；3例患者亦可见部分大网膜疝入 胸腔，13例CT轴位及MPR图像显示食管裂 孔的膈肌脚间距增大。结论 EHH临床表现 无特异性，易误诊。螺旋CT可以清晰显示 EHH的多种征象，对确诊不同类型的EHH及 其与相关疾病的鉴别有重要价值，可作为 上消化道造影或胃镜检查较好的补充检查 方法，为临床诊治提供依据。

Objective To improve the clinical understanding of Esophageal hiatal hernia (EHH) and to investigate its diagnostic value with spiral CT scan. Methods The CT imaging characteristics of 20 patients with EHH from Jul.2013 to Apr.2015 were analyzed which were diagnosed by upper gastrointestinal barium examination or gastroscopy. Results The hernia sac of 18 cases is in the front-left of descending aorta and spine and 7 cases locate in the front or on the right side of the spine. Among them, the hernia sac and "gastric mucosa in chest" of 20 cases were clearly demonstrated on CT images. The herniation of gastric body of 14 cases has a corset - like change. Morphology of hernia sac presents "Cable sign" in 2 cases. 6 cases with Oral contrast agents and 8 cases with CT enhanced scan of CT images show that gastric mucosathrough esophageal hiatusand homogeneous enhancement was detected in the hernia sac wall and the gastric wall after contrast administration. 3 cases of EHH were associated with greater omentuml via esophageal hiatus. The distance between thecrura of diaphragm was widened in 13 cases of EHH. Conclusions The atypical and non-specific symptoms of EHH result in high misdiagnosis rate. CT MPR can clearly display many characteristic signs of EHH. CT is helpful for the differential diagnosis of EHH, providing an important supplementary examination for patients with intolerance of upper gastrointestinal barium examination or gastroscopy.