摘要目的 探讨腹股沟斜疝、直疝和股疝的多排螺旋CT检查影像学特征.方法 采用回顾性横断面研究方法.收集2014年12月至2017年8月新乡医学院第一附属医院收治的106例斜疝、直疝和股疝患者的临床资料.患者行多排螺旋CT多平面重建检查.观察指标:(1)多排螺旋CT检查诊断斜疝、直疝和股疝的灵敏度、特异度、阳性预测值、阴性预测值及准确率.(2)多排螺旋CT检查示腹股沟区解剖情况.(3)多排螺旋CT检查示疝囊与周围结构关系.(4)疝内容物、疝囊在“十”字交叉法象限分区中所在象限及并发症.计数资料采用绝对数或百分比表示,比较采用行×列的x2检验.结果 (1)多排螺旋CT检查诊断斜疝、直疝和股疝的灵敏度、特异度、阳性预测值、阴性预测值及准确率:106例患者中斜疝66例(70个疝囊),直疝22例(27个疝囊),股疝18例(20个疝囊).多排螺旋CT检查诊断斜疝的灵敏度、特异度、阳性预测值及阴性预测值分别为95.7％、96.3％、98.5％及89.7％;诊断直疝的上述指标分别为96.3％、95.7％、89.7％及98.5％;诊断股疝的灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率均为100.0％;腹股沟疝(斜疝、直疝和股疝)的诊断符合率为95.9％,正确指数为0.920.(2)多排螺旋CT检查示腹股沟区解剖情况:106例患者的腹壁下动脉、腹股沟韧带、腹直肌、股静脉等解剖结构在横断位、冠状位及矢状位图像上均能辨认,6例患者腹股沟管内环观察不清;对于腹股沟管内环与腹壁下动脉的关系,以冠状位显示最佳,横断位次之,矢状位不易观察;对于腹股沟韧带与疝囊的关系以矢状位显示最佳,冠状位连续层面观察亦能明确显示,横断位显示较差;直疝三角及腹股沟管内环在斜冠状位显示最佳;股三角在冠状位显示最佳;侧新月征、“十”字交叉法象限分区需要在横断位观察.(3)多排螺旋CT检查示疝囊与周围结构关系:斜疝通过腹股沟管内环进入腹股沟管,疝囊位于腹壁下动脉外侧;直疝通过直疝三角疝出,疝囊位于腹壁下动脉内侧,92.6％ (25/27)伴侧新月征;斜疝与直疝疝囊均走行于腹股沟韧带前上方;股疝通过股三角疝出,疝囊位于腹股沟韧带后下方,位于耻骨结节的外侧.(4)疝内容物、疝囊在“十”字交叉法象限分区中所在象限及并发症:最常见的疝内容物为小肠,部分患者内容物由多种成份组成;斜疝内容物依次为小肠35个、肠系膜29个、积液25个、腹腔内脂肪9个、结肠8个、卵巢1个;直疝内容物依次为小肠14个、腹腔内脂肪11个、积液6个、肠系膜6个、结肠3个、膀胱2个;股疝内容物依次为小肠12个、腹腔内脂肪8个、积液3个、肠系膜2个.斜疝、直疝和股疝的疝容物比较,差异有统计学意义(x2=28.389,P＜0.05);斜疝、直疝和股疝的主体疝囊位于前外象限分别为70、27和15个,并且股疝还有5个疝囊仅位于后外象限,3种疝的疝囊在“十”字交叉法象限分区比较,差异有统计学意义(x2 =78.904,P＜0.05);斜疝、直疝及股疝发生肠梗阻分别为8、14、12例,3者比较,差异有统计学意义(x2=26.674,P＜0.05).结论 斜疝、直疝和股疝具有特征性影像学征像.多排螺旋CT多平面重建可以显示腹股沟区解剖细节,对斜疝、直疝和股疝的诊断与鉴别诊断有重要价值.尤其对疝内容物的显示及对并发症的诊断,为评估风险、制订定手术方案提供重要信息.

abstractsObjective To explore the features of multi-slice spiral computed tomography (MSCT) examination of indirect,direct and femoral inguinal hernia.Methods The retrospective cross-sectional study was conducted.The clinical data of 106 patients with indirect,direct and femoral inguinal hernia who were admitted to the First Affiliated Hospital of Xinxiang Medical University between December 2014 and August 2017 were collected.All the patients were diagnosed as inguinal hernia by MSCT examination and multi-planar reconstruction.Observation indicators:(1) sensitivity,specificity,positive and negative predictive values and diagnostic accordance rate of indirect,direct and femoral inguinal hernia by MSCT;(2) inguinal anatomic presentation in MSCT examination;(3) relationship between hernial sac and surrounding structures in MSCT examination;(4) hernia contents and quadrants of hernial sac in the quadrant partition with " cross intersect" method and complications.Count data were described as absolute number or percentage.Comparison of count data was done using the chi-square test with row multiplied by column.Results (1) Sensitivity,specificity,positive and negative predictive values and diagnostic accordance rate of indirect,direct and femoral inguinal hernia by MSCT:of 106 patients,66,22 and 18 were diagnosed as indirect hernia,direct hernia and femoral hernia with 70,27 and 20 hernial sacs respectively.Sensitivity,specificity,positive and negative predictive values of inguinal hernia by MSCT were respectively 95.7％,96.3％,98.5％,89.7％ in indirect hernia patients and 96.3％,95.7％,89.7％,98.5％ in direct hernia patients and 100.0％,100.0％,100.0％,100.0％ in femoral hernia patients,and diagnostic accordance rate of femoral hernia was also 100.0％.Diagnostic accordance rate of inguinal hernia was 95.9％,and correct index was 0.920.(2) Inguinal anatomic presentation in MSCT examination:transverse,coronal and sagittal imagings of inferior epigastric artery,inguinal ligament,musculus rectus abdominis,femoral vein and other anatomic structures can be identified,and internal ring of inguinal canal of 6 patients cannot be observed clearly.For relationship between internal ring of inguinal canal and inferior epigastric artery,coronal view was the best,transverse view was the next,and sagittal view was rarely observed.For relationship between inguinal ligament and hernial sac,sagittal view was the best,coronal view was also observed clearly by continuous planes,and transverse view was poor.The oblique coronal view was the best for the direct hernial triangle and internal ring of inguinal canal,and coronal view of femoral triangle was the best.The lateral crescent sign and quadrant partition of "ross intersect" method needed to be observed in transverse plane.(3) Relationship between hernial sac and surrounding structures in MSCT examination:indirect hernia entered into the inguinal canal through internal ring of inguinal canal,and hernial sac was located at the outside of inferior epigastric artery;direct hernia was out through triangle hernia,and hernial sac was located at the inside of inferior epigastric artery,92.6％ (25/27) patients were accompanied by lateral crescent sign.The indirect hernia and direct hernia went along the upper front of inguinal ligament;femoral hernia was out through femoral triangle hernia,and hernial sac was located at the lower back of inguinal ligament and the outside of the pubic tubercle.(4) The hernia contents and quadrants of hernial sac in the quadrant partition with "cross intersect" method and complications:the most common hernia content was small intestine,including partial patients with hernia content composed of various substances;indirect hernia contents included small intestine (35),mesentery (29),effusion (25),intraabdominal fat (9),colon (8) and ovary (1) in turn;direct hernia contents included small intestine (14),intraabdominal fat (11),effusion (6),mesentery (6),colon (3) and bladder (2) in turn;femoral hernia contents included small intestine (12),intraabdominal fat (8),effusion (3) and mesentery (2) in turn.There was a statistically significant difference in the hernia contents among indirect hernia,direct hernia and femoral hernia (x2=28.389,P＜0.05).The main hernial sac located at antero-external quadrant was respectively occurred in 70 hernial sacs of indirect hernia and 27 hernial sacs of direct hernia and 15 hernial sacs of femoral hernia,and 5 hernial sacs of femoral hernia were located at postero-external quadrant.There was a statistically significant difference in comparison of the quadrant partition with "cross intersect" method (x2 =78.904,P ＜ 0.05).The intestinal obstruction was respectively occurred in 8 patients with indirect hernia and 14 patients with direct hernia and 12 patients with femoral hernia,with a statistically significant difference (x2=26.674,P＜0.05).Conclusions Indirect hernia,direct hernia and femoral hernia have characteristic signs of imaging.MSCT can display precisely the anatomical details of inguinal region,which plays an important role in diagnosis and differential diagnosis of indirect hernia,direct hernia and femoral hernia,especially in display of hernia contents and diagnosis of complications,thus it can provide important information for evaluating risk and making operation plan.