腹外疝影像学诊断.ppt

1、腹外疝的影像学诊断,内蒙古自治区人民医院王敏,疝,指任何脏器或组织，由正常部位通过人体薄弱点、缺损或间隙进入另一部位。最多见于腹部。,刘福岭 主编.现代医学辞典.济南：山东科学技术出版社.1990.第485页.,腹疝,定义：腹腔内任何脏器或组织，由于各种原因，离开原来位置，经由先天存在的或后天形成的裂孔或间隙、薄弱区进另一部位称为腹疝。,腹外疝的分类,腹股沟疝股疝,脐疝切口疝,白线疝半月线疝,膈疝腰疝,闭孔疝会阴疝,腹外疝,按照发生部位分为以下10类,腹外疝的分类,腹外疝根据临床特点,腹外疝诊断、鉴别诊断,腹股沟斜疝,腹股沟直疝,闭孔疝,股疝,腹外疝,腹股沟斜疝,从腹壁下动脉外侧的腹股沟内环突

2、出，沿腹股沟管向内下前方斜行，再穿过腹股沟管外环形成的疝块，并可下降至阴囊（女性可至大阴唇），是最常见的一种疝。男性较女性好发，右侧较左侧好发。,腹股沟区解剖,Herniated large bowel in a 55- year-old man with hepatocellular carcinoma.,Bhosale P R et al. Radiographics 2008;28:819-835,2008 by Radiological Society of North America,腹股沟区横断面解剖,腹股沟斜疝,腹股沟斜疝,腹股沟斜疝,腹股沟直疝,定义：自直疝三角区（Hessel

3、bach）突出的疝，称腹股沟直疝，好发于中老年人和体弱者，与直疝三角区的肌肉和筋膜发育不全、肌肉萎缩退化以及腹内压力升高等诸多因素有关。,腹股沟直疝,腹股沟直疝,腹股沟直疝,闭孔疝,闭孔疝（obturator hernia）是指腹腔内脏器经过髋骨闭孔突出于股三角区而形成，系后天获得性疝，多见于老年体格瘦弱者，7080岁为高发年龄，尤其多见于经产或多产老年妇女。发病原因：与老年体弱、营养不良及骨盆宽大和闭孔较大有关。,闭孔大体解剖,临床特异征象,Howship-Romberg征 正常情况下，闭孔管内除有闭孔神经和血管通过外，其余空间为脂肪组织所填充。当闭孔疝发生时，疝囊及腹腔内容物被挤入一个狭小

4、、坚硬的管道内，即出现闭孔神经受压症状。临床上表现为腹股沟区及大腿内侧的刺痛、麻木、酸胀感，并向膝内侧放射，当咳嗽，伸腿外展、外旋时，由于内收肌对闭孔外肌的牵拉，可使闭孔神经受压加重，而至疼痛加剧，反之则减轻，称之为Howship-Romberg征。此征在闭孔疝中的发生率约为20.2%-100%不等,CT表现,未嵌顿时可见闭孔肌和耻骨肌之间有低密度影，肿块表现为较对侧明显不同的含气密度及肠管扩张；嵌顿后可见肠影从闭孔内侧进入闭孔，且该闭孔内肠影以上的肠管有肠梗阻征象，即可诊断闭孔疝。,术中表现,CT、术中表现,股疝,股疝,股疝（femoral hernia）是指经股环、股管并自卵圆窝突出的疝，

5、多为后天获得性，先天性股疝极其罕见。其发病与股环较宽、妊娠、肥胖、结缔组织退变、腹内压升高等因素有关，以中年以上妇女多见，约占腹外疝的5%。右侧好发,股管解剖,股疝,Extent of hernia sac was evaluated visually based on relationship between hernia sac and pubic tubercle on axial CT images.,Suzuki S et al. AJR 2007;189:W78-W83,2007 by American Roentgen Ray Society,Compression of fem

6、oral vein on CT scans through acetabula and pubic symphysis in 66-year-old woman.,Suzuki S et al. AJR 2007;189:W78-W83,2007 by American Roentgen Ray Society,股疝,股疝,腹股沟韧带,腹股沟区疝鉴别诊断,上述腹外疝鉴别诊断,谢谢大家,参考文献,1 Aguirre D A, Santosa A C, Casola G, et al. Abdominal wall hernias: imaging features, complications,

7、 and diagnostic pitfalls at multi-detector row CTJ. Radiographics,2005,25(6):1501-1520. 2 Suzuki S, Furui S, Okinaga K, et al. Differentiation of femoral versus inguinal hernia: CT findingsJ. AJR Am J Roentgenol,2007,189(2):W78-W83. 3 Toms A P, Dixon A K, Murphy J M, et al. Illustrated review of new

8、 imaging techniques in the diagnosis of abdominal wall herniasJ. Br J Surg,1999,86(10):1243-1249. 4 Shadbolt C L, Heinze S B, Dietrich R B. Imaging of groin masses: inguinal anatomy and pathologic conditions revisitedJ. Radiographics,2001,21 Spec No:S261-S271. 5 Robinson P, White L M, Agur A, et al.

9、 Obturator externus bursa: anatomic origin and MR imaging features of pathologic involvementJ. Radiology,2003,228(1):230-234. 6 Bhosale P R, Patnana M, Viswanathan C, et al. The inguinal canal: anatomy and imaging features of common and uncommon massesJ. Radiographics,2008,28(3):819-835, 913. 7 Yoon

10、 W, Kim J K, Jeong Y Y, et al. Pelvic arterial hemorrhage in patients with pelvic fractures: detection with contrast-enhanced CTJ. Radiographics,2004,24(6):1591-1605, 1605-1606. 8 Zhang H, Cong J C, Chen C S. Ileum perforation due to delayed operation in obturator hernia: a case report and review of

11、 literaturesJ. World J Gastroenterol,2010,16(1):126-130. 9 Cherian P T, Parnell A P. The diagnosis and classification of inguinal and femoral hernia on multisection spiral CTJ. Clin Radiol,2008,63(2):184-192.10 Cherian P T, Parnell A P. The diagnosis and classification of inguinal and femoral hernia on multisection spiral CTJ. Clin Radiol,2008,63(2):184-192.,