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1、腹外疝的影像学诊断腹外疝的影像学诊断 内蒙古自治区人民医院内蒙古自治区人民医院王敏王敏疝疝 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.腹疝腹疝 定义:腹腔内任何脏定义:腹腔内任何脏器或组织,由于各种器或组织,由于各种原因,离开原来位置,原因,离开原来位置,经由先天存在的或后经由先天存在的或后天形成的裂孔或间隙、天形成的裂孔或间隙、薄弱区进另一部位称薄弱区进另一部位称为腹疝。为腹疝。腹疝腹外疝腹内疝腹外疝的分类腹外疝的分类腹股沟疝腹股沟疝腹股沟疝腹股沟疝股疝股疝股疝股疝脐疝脐疝切口
2、疝切口疝白线疝白线疝白线疝白线疝半月线疝半月线疝半月线疝半月线疝膈疝膈疝膈疝膈疝腰疝腰疝腰疝腰疝闭孔疝闭孔疝闭孔疝闭孔疝会阴疝会阴疝会阴疝会阴疝腹外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的分类腹外疝腹外疝根据临床特点腹外疝根据临床特点腹外疝诊断、鉴别诊断腹外疝诊断、鉴别诊断腹股沟斜疝腹股沟斜疝腹股沟直疝腹股沟直疝闭孔疝孔疝股疝股疝腹外疝腹外疝腹外疝腹外疝腹股沟斜疝腹股沟斜疝n n从腹壁下动脉外侧的从腹壁下动脉外侧的腹股沟内环突出,沿腹股沟内环突出,沿腹股沟管向内下前方腹股沟管向内下前方斜行,再穿过腹股沟斜行,再穿过腹股沟管外环形成的疝块,管外环形成的疝块,并可下降至阴囊(女并可下
3、降至阴囊(女性可至大阴唇),是性可至大阴唇),是最常见的一种疝。男最常见的一种疝。男性较女性好发,右侧性较女性好发,右侧较左侧好发。较左侧好发。腹股沟区解剖腹股沟区解剖Herniatedlargebowelina55-year-oldmanwithhepatocellularcarcinoma.BhosalePRetal.Radiographics2008;28:819-8352008 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斜疝腹股沟斜疝腹股沟斜疝腹股沟直疝腹股沟直疝n n定义:自直疝三角区定义:自
4、直疝三角区(HesselbachHesselbach)突出的)突出的疝,称腹股沟直疝,疝,称腹股沟直疝,好发于中老年人和体好发于中老年人和体弱者,与直疝三角区弱者,与直疝三角区的肌肉和筋膜发育不的肌肉和筋膜发育不全、肌肉萎缩退化以全、肌肉萎缩退化以及腹内压力升高等诸及腹内压力升高等诸多因素有关。多因素有关。腹股沟直疝腹股沟直疝腹股沟直疝腹股沟直疝腹股沟直疝腹股沟直疝闭孔疝闭孔疝n n闭孔疝(闭孔疝(obturator herniaobturator hernia)是指腹腔内脏器经过髋骨是指腹腔内脏器经过髋骨闭孔突出于股三角区而形闭孔突出于股三角区而形成,系后天获得性疝,多成,系后天获得性疝,多
5、见于老年体格瘦弱者,见于老年体格瘦弱者,70807080岁为高发年龄,尤岁为高发年龄,尤其多见于经产或多产老年其多见于经产或多产老年妇女。妇女。n n发病原因:与老年体弱、发病原因:与老年体弱、营养不良及骨盆宽大和闭营养不良及骨盆宽大和闭孔较大有关。孔较大有关。闭孔大体解剖闭孔大体解剖临床特异征象临床特异征象n nHowship-RombergHowship-Romberg征征 正常情况下,闭孔管内除有正常情况下,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填充。当闭孔疝发生时,疝囊及腹腔内容物被挤入
6、一个狭小、坚硬的管道内,即出现闭孔神经受入一个狭小、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,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,称之为之则减轻,称之为Howship-RombergHowship-Romberg征。此征在闭征。此征在闭孔疝中的发生率约为孔疝中的发生率约为20.2%-100%20.2%
7、-100%不等不等CT表现表现n n未嵌顿时可见闭孔肌未嵌顿时可见闭孔肌和耻骨肌之间有低密和耻骨肌之间有低密度影,肿块表现为较度影,肿块表现为较对侧明显不同的含气对侧明显不同的含气密度及肠管扩张;嵌密度及肠管扩张;嵌顿后可见肠影从闭孔顿后可见肠影从闭孔内侧进入闭孔,且该内侧进入闭孔,且该闭孔内肠影以上的肠闭孔内肠影以上的肠管有肠梗阻征象,即管有肠梗阻征象,即可诊断闭孔疝。可诊断闭孔疝。术中表现术中表现CT、术中表现、术中表现股疝股疝股疝股疝n n股疝(femoral hernia)是指经股环、股管并自卵圆窝突出的疝,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
8、、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管解剖股疝股疝ExtentofherniasacwasevaluatedvisuallybasedonrelationshipbetweenherniasacandpubictubercleonaxialCTimages.SuzukiSetal.AJR2007;189:W78-W832007 by American Roentgen Ray SocietyCompressionoffemoralveinonCTscansthroughacetabulaandpubicsymphysisin66-year-oldwo
9、man.SuzukiSetal.AJR2007;189:W78-W832007 by American Roentgen Ray Society股疝股疝股疝股疝腹股沟韧带腹股沟韧带腹股沟区疝鉴别诊断腹股沟区疝鉴别诊断斜疝斜疝直疝直疝发生率94%6%好发年龄儿童及青壮年老年突出路径经腹股沟管突出经Hesselbach三角突出疝块外形椭圆形或梨形,基底细半球形,基底宽疝内容物还纳后压迫内环疝块不突出疝块仍突出疝囊和精囊的关系精索在疝囊后方精索在疝囊前外侧疝囊颈和腹壁下动脉的关系疝囊颈在其外侧疝囊颈在其内侧嵌顿情况易不易上述腹外疝鉴别诊断上述腹外疝鉴别诊断腹股沟疝闭孔疝股疝疝块位置腹股沟韧带上方,耻
10、骨结节内上耻骨肌、闭孔外肌间腹股沟韧带下方,耻骨结节外下股静脉受压很少见很常见与精索关系斜疝与精索紧密相邻反之突出路径经腹股沟管或Hesselbach三角经闭孔管于耻骨肌深层、股三角的下端突出经股管疝入,并于股静脉内侧的卵圆窝突出谢谢大家谢谢大家参考文献n n 1 Aguirre D A, Santosa A C, Casola G, et al. Abdominal wall hernias: imaging features, complications, 1 Aguirre D A, Santosa A C, Casola G, et al. Abdominal wall hernias
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