CAJ | 학술논문

目的：探讨腰疝(LH)的多层螺旋 CT(MSCT)表现特征及后处理重建技术在 LH 诊治中的临床价值。方法收集经手术病理证实的 LH 16例,回顾性分析其临床和影像学资料。结果 MSCT 诊断 LH 16例共17疝,其中腰上三角疝12例13个(76.5%),腰下三角疝3例(17.6%),弥漫性 LH 1例(5.9%)。疝环直径约1.5~9.3 cm,疝囊大小约1.8 cm×2.4 cm~11.3 cm×6.2 cm。LH 在 MSCT 上表现为腹腔、腹膜后组织或器官经缺损的腰三角间隙向腰背部皮下、皮下软组织内突出的类圆形或烧瓶样肿块。腰上三角疝上界为第12肋下缘,外界为腹内斜肌内缘,内界为竖脊肌、腰方肌的外缘。腰下三角疝的内界为背阔肌前缘,外界为腹外斜肌后缘,下界为髂嵴。17个 LH 中,疝内容物为结肠及其系膜3例,小肠2例,其中1例为嵌顿性 LH 合并小肠梗阻,其余12个 LH 的内容物均为后腹膜脂肪组织及系膜。16例均行疝修补术,术前依据 MSCT 表现选择合适的手术修补方式,术中均符合LH,术后随访均无复发。结论 LH 具有特征性 CT 表现,MSCT 容积扫描结合后处理重建能清晰显示 LH 的类型、大小、疝内容物以及并发症发生情况,能为 LH 的诊断和鉴别诊断以及疝修补术提供重要的信息。
목적：탐토요산(LH)적다층라선 CT(MSCT)표현특정급후처리중건기술재 LH 진치중적림상개치。방법수집경수술병리증실적 LH 16례,회고성분석기림상화영상학자료。결과 MSCT 진단 LH 16례공17산,기중요상삼각산12례13개(76.5%),요하삼각산3례(17.6%),미만성 LH 1례(5.9%)。산배직경약1.5~9.3 cm,산낭대소약1.8 cm×2.4 cm~11.3 cm×6.2 cm。LH 재 MSCT 상표현위복강、복막후조직혹기관경결손적요삼각간극향요배부피하、피하연조직내돌출적류원형혹소병양종괴。요상삼각산상계위제12륵하연,외계위복내사기내연,내계위수척기、요방기적외연。요하삼각산적내계위배활기전연,외계위복외사기후연,하계위가척。17개 LH 중,산내용물위결장급기계막3례,소장2례,기중1례위감돈성 LH 합병소장경조,기여12개 LH 적내용물균위후복막지방조직급계막。16례균행산수보술,술전의거 MSCT 표현선택합괄적수술수보방식,술중균부합LH,술후수방균무복발。결론 LH 구유특정성 CT 표현,MSCT 용적소묘결합후처리중건능청석현시 LH 적류형、대소、산내용물이급병발증발생정황,능위 LH 적진단화감별진단이급산수보술제공중요적신식。
Objective To explore the imaging appearances and the value of multi-slice CT (MSCT)with post-processing tech-niques in diagnosis and treatment of lumbar hernia (LH).Methods The imaging and clinical data of 1 6 patients with LH which were confirmed by surgery were analyzed retrospectively.Results In 1 6 patients,1 7 lesions of LH were revealed by MSCT.There were superior lumbar hernias in 13 (76.5%),inferior lumbar hernias in 3 (1 7.6%)and diffuse lumbar hernia in 1 (5.9%).Hernia ring in diameter ranged from 1.5 to 9.3 cm,and the hernia sac size ranged from 1.8 cm×2.4 cm to 1 1.3 cm× 6.2 cm.MSCT showed oval or flask shaped mass of extraperitioneal fat with or without peritoneum and visceral contents protruded through the de-fecting fascia floor into lumbar triangle.Superior lumbar hernia was bounded by the 12th rib superiorly,the erector spine muscle medially and the internal oblique muscle laterally.Inferior lumbar hernia was bounded by latissimus dorsi muscle medially,the ex-ternal oblique muscle laterally and the iliac crest inferiorly.Hernia contents included colon in 3 patients and small bowel in 2 with in-carcerated hernia with small bowel obstruction in 1,and adipose tissue and mesentery in other 12.All patients received surgery treatment,and the appropriate surgical methods were selected according to the MSCT findings.The surgical findings were consistent with MSCT results.No recurrence was found during follow-up.Conclusion LH has characteristic CT manifestations.MSCT volu-metric scanning with post-processing techniques can clearly display the type of LH,the size of abdominal wall defect,hernia contents and their complications.It is helpful for diagnosis of the LH and differentiation from other diseases,which may provide important information for clinical surgery.