分析多层螺旋CT对腹股沟疝的分型鉴别及应用价值。

选择2018年5月至2021年3月于宁国市人民医院外科收治的102例腹股沟疝患者作为研究对象，观察分析多层螺旋CT检查斜疝、直疝、股疝的类型，多层螺旋CT诊断与手术结果对比，多层螺旋CT检查的诊断效能，多层螺旋CT横断位、冠状位及矢状位的诊断符合率，多层螺旋CT检查腹股沟疝的影像学征象。

102例患者中单纯性斜疝70例，单纯性直疝20例，单纯性股疝5例，左侧复发性腹股沟直疝2例，右侧嵌顿性腹股沟股疝5例。CT诊断与手术结果相符的斜疝占64.71%（66/102），直疝占16.67%（17/102），股疝占6.86%（7/102）。多层螺旋CT诊断斜疝的特异度、灵敏度、阳性预测值分别为8.33%、91.67%、91.67%；直疝的特异度、灵敏度、阳性预测值分别为15.00%、85.00%、85.00%；股疝的特异度、灵敏度、阳性预测值分别为30.00%、70.00%、70.00%。多层螺旋CT冠状位的诊断符合率为99.02%，稍高于矢状位的98.04%（P>0.05）；冠状位的诊断符合率为99.02%，明显高于横断位的75.49%（P<0.05）；矢状位的诊断符合率为98.04%，明显高于横断位的75.49%（P<0.05）。102例患者共有疝囊105个，斜疝患者有72个疝囊，直疝患者有23个疝囊，股疝患者有10个疝囊。93.06%（67/72）的斜疝疝囊的腹股沟管内环扩大，直疝及股疝疝囊的腹股沟管内环均正常；斜疝及直疝疝囊均无股三角填塞，股疝疝囊均股三角填塞；斜疝及股疝疝囊均无侧新月征，82.61%（19/23）的直疝疝囊具有侧新月征；斜疝及直疝疝囊位于腹股沟韧带的前方，股疝疝囊均位于腹股沟韧带的后方；90.28%（65/72）的斜疝疝囊壁位于腹壁下动脉的外侧，直疝疝囊壁位于腹壁下动脉的内侧，股疝疝囊壁位于腹壁下动脉的后下方。

多层螺旋CT检查有助于腹股沟疝的诊断，与临床对腹股沟区解剖结构的了解相结合，对腹股沟直疝、斜疝及股疝的分型具有重要价值。

To analyze the classification and application value of MSCT in inguinal hernia.

A total of 102 patients with inguinal hernia admitted to the Department of Surgery at Ningguo People's Hospital from May 2018 to March 2021 were selected as the research objects. The types of oblique hernia, direct hernia and femoral hernia examined by MSCT were analyzed, the diagnosis and surgical results of MSCT were compared, and the diagnostic efficacy of MSCT was analyzed. The diagnostic coincidence rate of MSCT in transverse, coronal and sagittal positions was compared to analyzing the imaging signs of inguinal hernia by MSCT.

Among the 102 patients, 70 were simple oblique hernia, 20 were simple direct hernia, 5 were simple femoral hernia, 2 were left recurrent direct inguinal hernia, and 5 were right incarcerated inguinal and femoral hernia. The CT diagnosis of oblique hernia was 64.71% (66/102), direct hernia 16.67% (17/102), and femoral hernia 6.86% (7/102). The specificity, sensitivity, and positive predictive value of MSCT in the diagnosis of oblique hernia were 8.33%, 91.67% and 91.67%, respectively. The specificity, sensitivity, and positive predictive value of direct hernia were 15.00%, 85.00% and 85.00%, respectively. The specificity, sensitivity, and positive predictive value of femoral hernia were 30.00%, 70.00%, and 70.00%, respectively. The diagnostic coincidence rate of coronal slice CT was 99.02%, slightly higher than that of sagittal slice CT 98.04% (P>0.05). The diagnostic coincidence rate of coronal position was 99.02%, significantly higher than that of transverse position 75.49% (P<0.05). The diagnostic coincidence rate of the sagittal position was 98.04%, which was significantly higher than the 75.49% of the transverse position (P<0.05). There were 105 hernia sacs in 102 patients, 72 hernia sacs in oblique hernia patients, 23 hernia sacs in direct hernia patients, and 10 hernia sacs in femoral hernia patients. The inguinal canal ring was enlarged in 93.06% (67/72) of the oblique hernia sacs, and the inguinal canal ring was normal in direct hernia and femoral hernia sacs. There was no femoral trigonal packing in the hernia sacs of oblique and direct hernia, and femoral trigonal packing in the hernia sacs of femoral hernia; the lateral crescent sign was not found in oblique hernia and femoral hernia sacs. 82.61% (19/23) of straight hernia sacs had a lateral crescent sign. The oblique and direct hernia sacs are located in front of the inguinal ligament, while the femoral hernia sacs are located behind the inguinal ligament. 90.28% (65/72) of the oblique hernia sac wall was lateral to the inferior epigastric artery, the direct hernia sac wall was medial to the inferior epigastric artery, and the femoral hernia sac wall was posterior and inferior to the inferior epigastric artery.

Multi-slice spiral CT is helpful in the diagnosis of inguinal hernia, and when combined with the clinical understanding of the anatomical structure of the inguinal region, it is of great value in the classification of direct inguinal hernia, oblique hernia, and femoral hernia.