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,
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