肠系膜裂孔型腹内疝临床及影像学诊断价值.docVIP

肠系膜裂孔型腹内疝临床及影像学诊断价值 　　【摘要】 目的 探?肠系膜裂孔型腹内疝的临床与影像学表现。方法 回顾性分析经手术证实的14例肠系膜裂孔型腹内疝患者的临床与影像学表现。结果 14例患者均经手术证实， 一般临床表现为腹胀腹痛， 伴有恶心、呕吐等肠梗阻症状， 术中见肠系膜根部有缺损， 为长约2.5～4.0 cm的裂孔， 平均3.0 cm， 经裂孔疝入的小肠形成闭袢， 3例合并小肠坏死， 1例合并系膜扭转及中毒性休克。CT表现为中上腹部平行排列肠管6例， 簇状排列5例， “M”型或“C”型肠袢3例， 肠管均见积液扩张；小肠肠管管壁增厚2例， 肠系膜血管呈缆绳征10例， 束带征3例， 漩涡征1例， 横结肠向后方移位1例， 降结肠向外侧移位1例， 左侧肾脏受压向后移位1例， 胰腺向后方移位1例， 十二指肠移位3例。结论 肠系膜裂孔型腹内疝一般以腹胀腹痛等急腹症为首发症状， CT表现为异常排列的肠管， 可见伴有肠管积液扩张， 并具有占位效应， 肠系膜血管呈缆绳征、漩涡征， 熟悉掌握肠系膜裂孔型腹内疝的临床与影像学表现， 对提高肠系膜裂孔型腹内疝的术前诊断， 指导临床治疗， 把握手术时机有重要意义。 　　【关键词】 肠系膜裂孔型腹内疝；CT；肠梗阻； 诊断 　　DOI：10.14163/j.cnki.11-5547/r.2018.09.010 　　【Abstract】 Objective To discuss the clinical and imaging findings of mesenteric fracture of intra-abdominal hernia. Methods The clinical and imaging findings of 14 patients with mesenteric fracture of intra-abdominal hernia confirmed by surgery was retrospectively analyzed. Results 14 cases were confirmed by surgery， the general clinical manifestations were abdominal pain， nausea and vomiting and other symptoms of bowel obstruction. During the operation， there was a defect in the mesenteric roots， a hole about 2.5～4.0 cm， with an average of 3.0 cm. The small intestine formed a closed loop through the hiatal hernia， 3 cases had intestinal necrosis， and 1 case had mesangial torsion and toxic shock. CT showed upper abdomen parallel arrangement of intestine in 6 cases， clustered arrangement in 5 cases， M or C type intestinal loop in 3 cases， and fluid expansion could be seen in intestine； intestinal wall thickening in 2 cases， mesenteric vascular cable sign in 10 cases， bundles sign in 3 cases ， whirlpool sign in 1 case， transposition of the transverse colon to the rear in 1 case， descending colon to the lateral displacement in 1 case， left renal compression in the backward displacement in 1 case， pancreas in the posterior displacement in 1 case， duodenal displacement in 3 cases. Conclusion The mesenteric fracture of intra-abdominal hernia is usually characterized by abdominal distention， abdomi