Diagnosis of Inguinal Region Hernia in Multi-detector Row CT_West China Medical Journal

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Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R.China;

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Keywords：

疝; 腹股溝區; 診斷; 斷層攝影術/X線計算機; 重建

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【摘要】目的 評價多排螺旋CT（MDCT）在腹股溝區疝診斷中的價值。方法回顧性分析2009年6-12月96例經臨床證實為腹股溝區疝患者的CT圖像資料。通過多平面重建技術獲得冠狀位及矢狀位圖像，評價不同平面圖像在腹股溝區疝診斷及分類中的應用價值。結果 63例斜疝患者（66疝）疝囊于腹壁下動脈外側經腹股溝深環進入腹股溝管，疝囊位于精索或圓韌帶前側（43/66，65.2%）或前內側（15/66，22.7%）；30例直疝患者（37疝）疝囊位于腹壁下動脈內側，位于精索內側（27/37，73.0%）；斜疝及直疝疝囊均走行于腹股溝韌帶前上方；3例股疝患者（3疝）疝囊位于腹股溝韌帶后下方，冠狀位“影像學股三角”內。結論 MDCT對腹股溝區疝的診斷與鑒別診斷具有重要價值，可為手術前評估及手術中操作提供重要參考信息。
【Abstract】 Objective To assess the value of multi-detector row CT (MDCT) in diagnosis of the inguinal region hernia. Methods The CT images of 96 patients with inguinal region hernia from June to December 2009 were retrospectively analyzed. The diagnosis and application of coronal and sagittal views in inguinal region hernia were assessed by multi-planer reconstruction. Results Hernia sac in 63 indirect hernia patients (66 hernias) originated lateral to the inferior epigastric artery enter the inguinal canal through the deep ring, anterior (43/63,68.3%) or anteromedial (15/63,23.8%) to the spermatic cord or round ligament;sac in 30 direct hernia patients (37 hernias) originated medial to the inferior epigastric artery, medial to the spermatic cord;both indirect and direct hernia sac located anterosuperior to the inguinal ligament;sac in three femoral hernia patients (three hernias) located posterior to the inguinal ligament and inside the “radiological femoral triangle” of coronal views. Conclusion MDCT plays on important role in diagnosing the inguinal region hernia, and provides critical information for preoperative and intraoperative.

Citation： ZHAO Shuang,LIU Rongbo,ZHOU Ying,ZHOU Haiying. Diagnosis of Inguinal Region Hernia in Multi-detector Row CT. West China Medical Journal, 2010, 25(9): 1670-1672. doi: Copy

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12.	Saber AA, Meslemani AM, Davis R, et al. Safety zones for anterior abdominal wall entry during laparoscopy: a CT scan mapping of epigastric vessels [J]. Ann Surg, 2004, 239 (2): 182-185.
13.	羊惠君, 王懷經, 王建本, 等. 實地解剖學[M]. 北京: 人民衛生出版社, 2002: 208-209.
14.	Kitami M, Takase K, Tsuboi M, et al. Differentiation of femoral and inguinal hernias on the basis of anteroposterior relationship to the inguinal ligament on multidimensional computed tomography[J]. J Comput Assist Tomogr, 2009, 33(5): 678-681.
15.	Suzuki S, Furui S, Okinaga K, et al. Differentiation of femoral versus inguinal hernia: CT findings [J]. AJR Am J Roentgenol, 2007, 189(2): 78-83.

1. 李富年, 周榮祥, 李揚, 等. 腹壁與疝外科學[M]. 北京: 人民衛生出版社, 2004: 211-240.
2. van den Berg JC, de Valois JC, Go PM, et al. Radiological anatomy of the groin region[J]. Eur Radiol, 2000, 10(4): 661-670.
3. Cherian PT, Parnell AP. Radiologic anatomy of the inguinofemoral region: insights from MDCT [J]. AJR Am J Roentgenol, 2007, 189(4): 177-183.
4. Cherian PT, Parnell AP. The diagnosis and classification of inguinal and femoral hernia on multisection spiral CT [J]. Clini Radiol, 2008, 63(2): 184-192.
5. Ianora AA, Midiri M, Vinci R, et al. Abdominal wall hernias: imaging with spiral CT[J]. Eur Radiol, 2000, 10(6): 914-919.
6. Delabrousse E, Michalakis D, Sarliève P, et al. Value of the pubic tubercle as a CT reference point in groin hernias[J]. J Radiol, 2005, 86(6): 651-654.
7. Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients [J]. Hernia, 2009, 13(4): 343-403.
8. Felix EL, Harbertson N, Vartanian S. Laparoscopic hernioplasty: significant complications[J]. Surg Endosc, 1999, 13(4): 328-331.
9. Knook MT, Weidema WF, Stassen LP, et al. Endoscopic totally extraperitoneal repair of bilateral inguinal hernias[J]. Br J Surg, 1999, 86(10): 1312-1316.
10. Knook MT, Weidema WF, Stassen LP, et al. Laparoscopic repair of recurrent inguinal hernias after endoscopic herniorrhaphy[J]. Surg Endosc, 1999, 13(11): 1145-1147.
11. 秦良譽, 夏春波, 周思, 等. 腹壁下動脈的應用解剖與臨床意義 [J]. 華夏醫學, 2007, 20 (5): 898-899.
12. Saber AA, Meslemani AM, Davis R, et al. Safety zones for anterior abdominal wall entry during laparoscopy: a CT scan mapping of epigastric vessels [J]. Ann Surg, 2004, 239 (2): 182-185.
13. 羊惠君, 王懷經, 王建本, 等. 實地解剖學[M]. 北京: 人民衛生出版社, 2002: 208-209.
14. Kitami M, Takase K, Tsuboi M, et al. Differentiation of femoral and inguinal hernias on the basis of anteroposterior relationship to the inguinal ligament on multidimensional computed tomography[J]. J Comput Assist Tomogr, 2009, 33(5): 678-681.
15. Suzuki S, Furui S, Okinaga K, et al. Differentiation of femoral versus inguinal hernia: CT findings [J]. AJR Am J Roentgenol, 2007, 189(2): 78-83.

West China Medical Journal

Diagnosis of Inguinal Region Hernia in Multi-detector Row CT

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