切换至 "中华医学电子期刊资源库"

中华疝和腹壁外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (02) : 228 -233. doi: 10.3877/cma.j.issn.1674-392X.2024.02.020

论著

多层螺旋CT并多平面重建技术在非裂孔性膈疝与膈膨升术前诊断中的应用
赵智勇1, 闫玉昌1, 关磊2, 金淑溶1, 潘振宇1,()   
  1. 1. 100043 首都医科大学附属北京朝阳医院京西院区放射科
    2. 100043 首都医科大学附属北京朝阳医院疝和腹壁外科
  • 收稿日期:2023-10-29 出版日期:2024-04-18
  • 通信作者: 潘振宇

Application of multi-slice spiral CT combined with multi-planar reconstruction in preoperative diagnosis of non-hiatal diaphragmatic hernia and diaphragmatic eventration

Zhiyong Zhao1, Yuchang Yan1, Lei Guan2, Shurong Jin1, Zhenyu Pan1,()   

  1. 1. Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China
    2. Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China
  • Received:2023-10-29 Published:2024-04-18
  • Corresponding author: Zhenyu Pan
引用本文:

赵智勇, 闫玉昌, 关磊, 金淑溶, 潘振宇. 多层螺旋CT并多平面重建技术在非裂孔性膈疝与膈膨升术前诊断中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 228-233.

Zhiyong Zhao, Yuchang Yan, Lei Guan, Shurong Jin, Zhenyu Pan. Application of multi-slice spiral CT combined with multi-planar reconstruction in preoperative diagnosis of non-hiatal diaphragmatic hernia and diaphragmatic eventration[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(02): 228-233.

目的

分析和探究多层螺旋CT并多平面重建技术在非裂孔性膈疝与膈膨升术前评价中的应用及临床意义。

方法

选取2017年8月至2023年8月于首都医科大学附属北京朝阳医院西院区行手术证实的非裂孔性膈疝27例、膈膨升11例患者,对其影像学资料、临床手术资料进行回顾性分析,总结易误诊点及鉴别点。应用多平面重建技术测量膈疝疝口左右径数值及前后径数值,并与术中测量的径线值进行比较,检验之间相关性。

结果

手术证实为膈疝27例患者中,经CT薄层扫描并多平面重建技术观察影像诊断为膈疝24例,影像诊断准确率为88.88%(24/27);手术证实为膈膨升11例患者中,经影像观察诊断为膈膨升8例,准确率为72.72%(8/11)。关于膈疝左右径值、前后径值,多层螺旋CT多平面重建上与术中测量的值比较,差异均无统计学意义(P>0.05);左右径值、前后径值各自间均具有较强相关性(r=0.97,0.99;均P<0.01)。

结论

多层螺旋CT在非裂孔性膈疝与膈膨升术前准确诊断中发挥重要作用,辅以多平面重建技术观察可明显提高术前诊断准确率。多平面重建可多角度显示膈肌形态,准确判断膈肌的完整性及分辨胸腹腔邻近结构,并在相应手术方式的选择及膈疝修补术前合适大小疝补片选择上有较大临床指导意义。

Objective

To analyze and explore the application and clinical significance of multi-slice spiral CT combined with multi-planar reconstruction in preoperative evaluation of non-hiatal diaphragmatic hernia and diaphragmatic eventration.

Methods

From August 2017 to August 2023, 27 cases of non-hiatal diaphragmatic hernia and 11 cases of diaphragmatic eventration confirmed by surgery in the West Campus of Beijing Chaoyang Hospital, Capital Medical University were selected. The imaging data and clinical operation data were retrospectively analyzed, and the points of misdiagnosis and differentiation were summarized. The left-right diameters and the anterior-posterior diameters of diaphragmatic hernia were measured by multi-planar reconstruction technique, and were compared with the diameters measured during operation, and the correlation between them was tested.

Results

Among 27 cases of diaphragmatic hernia confirmed by operation, 24 cases were diagnosed as diaphragmatic hernia by thin-slice CT scanning and multi-planar reconstruction, and the accuracy rate of image diagnosis was 88.88% (24/27). Of the 11 cases of diaphragmatic eventration confirmed by operation, 8 cases were diagnosed as diaphragmatic eventration by imaging observation, and the accuracy rate was 72.72% (8/11). In terms of the left-right diameters and the anterior-posterior diameters of diaphragmatic hernia, there was no significant difference between the values measured by multi-planar reconstruction technique and those measured during operation (P>0.05). There was a strong correlation between the left-right diameter and the anterior-posterior diameter (r=0.97, 0.99; both P<0.01).

Conclusion

Multi-slice spiral CT plays an important role in the accurate preoperative diagnosis of non-hiatal diaphragmatic hernia and diaphragmatic eventration. The accuracy of preoperative diagnosis can be significantly improved by using multi-planar reconstruction technology. Multi-planar reconstruction can display the shape of diaphragm from multiple angles, accurately judge the integrity of diaphragm and distinguish the adjacent structures of thorax and abdominal cavity, and it has great clinical guiding significance in the selection of corresponding surgical methods and appropriate hernia mesh before diaphragmatic hernia repair.

图1 膈疝形态及特异性征象注:1A横轴位。左侧膈疝,显示部分胃、胰腺等位于胸腔内,内脏后移,紧贴后方胸廓组织、后肋面(白箭),呈内脏依附征,膈疝典型征象,膈肌缺口观察差。1B冠状位。清楚显示膈肌缺损,胃及腹腔脂肪疝口处局部受压呈狭颈征,可准确测量膈疝口左右径。1C矢状位。疝囊向上推移邻近肺组织,肺下叶局部肺不张,膈肌缺损明确,可清晰观察、测量膈疝前后径。膈肌缺损处胃腔局部受压聚拢(白箭),呈狭颈征改变。1D、1E VR冠状位/矢状位。三维重建彩图更加直观显示疝口及疝囊内容物,以及受压肺组织及肺血管改变。
图3 误诊为膈膨升的膈疝注:3A冠状位。本例左侧膈疝误诊为膈膨升,膈肌断裂处(白箭)不易观察到,且疝入的胃泡饱满膨隆向上挤压胃上缘,紧贴左肺下叶,形成假性光滑膈面(黄箭),易误诊为膈膨升。冠状位见胃腔经过疝口时聚拢狭窄,形成狭颈征(黑箭)。3B横轴位。横轴位见狭颈征(白箭),膈膨升无此征象。
图4 膈膨升形态及征象注:4A横轴位。左侧膈膨升,胸腔位置见胃肠、胰腺影,胃肠未见聚拢征象,肠管分散,位置均正常,胃肠胰腺未见后移。4B、4C冠状位/矢状位。膈肌完整,未见明确缺口,膈肌连续并与同侧腹腔器官一起抬高。
图2 误诊为张力性气胸的创伤性巨大膈疝的形态及特征注:2A~2C横轴位肺窗/横轴位软组织窗/矢状位软组织窗。左侧创伤性巨大膈疝,疝入胸腔巨大胃泡(黑箭),横轴位易误诊为张力性气胸,矢状位图像显示巨大胃紧贴前胸壁,内见气液平。
图5 多层螺旋CT多平面重建上与术中测量的数值做一致性评价注:5A、5B分别对膈疝左右径值、前后径值测量所得两种数据进行Bland-Altman图一致性分析,显示一致性较好。
[1]
Portelli M, Bugeja M, Cini C. Left-sided bochdalek's hernia in a young adult: a case report and literature review[J]. Surg J(N Y), 2021, 7(3): e124-e126.
[2]
Abdelhamid AT. Non-traumatic left-sided diaphragmatic hernia causing volvulus in an adult[J]. Radiol Case Rep, 2023, 18(3): 899-902.
[3]
Marichez A, Fernandez B, Chiche L. Bochdalek diaphragmatic hernia with bowel incarceration[J]. J Visc Surg, 2021, 158(4): 362-363.
[4]
Sallout B, Alshebli D, Sallout L, et al. Fetal diaphragmatic eventration: a case report[J]. J Obstet Gynaecol Can, 2021, 43(8): 993-997.
[5]
Pradhan P, Karmacharya RM, Vaidya S, et al. Case report of eventration of diaphragm due to an unknown febrile illness causing phrenic nerve palsy and other multiple nerve palsies[J]. Ann Med Surg(Lond), 2020, 54: 74-78.
[6]
Giuffrida M, Perrone G, Abu-Zidan F, et al. Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper[J]. World J Emerg Surg, 2023, 18(1): 43.
[7]
Levine SH. Diaphragmatic hernia[J]. Vet Clin North Am Small Anim Pract, 1987, 17(2): 411-430.
[8]
Predescu D, Achim F, Socea B, et al. Rare diaphragmatic hernias in adults-experience of a tertiary center in esophageal surgery and narrative review of the literature[J]. Diagnostics(Basel), 2023, 14(1): 85.
[9]
Yucel M, Kulali F, Yildiz A. Development of diaphragmatic hernia in patients with penetrating left thoracoabdominal stab wounds[J]. World J Surg, 2022, 46(8): 1872-1877.
[10]
Cremonini C, Lewis MR, Jakob D, et al. Diagnosing penetrating diaphragmatic injuries: CT scan is valuable but not reliable[J]. Injury, 2022, 53(1): 116-121.
[11]
Muien MZA, Jeyaprahasam K, Krisnan T, et al. Rare late-presentation congenital diaphragmatic hernia mimicking a tension pneumothorax[J]. Radiol Case Rep, 2021, 16(9): 2542-2545.
[12]
Rajkarnikar R, Thami R, Dahal P, et al. An infant with congenital diaphragmatic eventration with dextrocardia: a case report[J]. JNMA J Nepal Med Assoc, 2022, 60(247): 314-317.
[13]
Gunia DM, Porter DJ, Alijani A, et al. A tale of two unconventional adult diaphragmatic hernias[J]. Ann R Coll Surg Engl, 2023, 105(5): 484-488.
[14]
Misimi S, Shurlani A, Nikolovski A. Incidentally diagnosed large asymptomatic morgagni hernia in adult male patient[J]. Eur J Case Rep Intern Med, 2023, 10(10): 004047.
[15]
Zhang Z, Fu Y, Hu B. Three-dimensional reconstruction model in the diagnosis of Morgagni's hernia[J]. BMJ Case Rep, 2021, 14(2): e239911.
[16]
Saxena AK, Hayward RK. Patches in congenital diaphragmatic hernia: a systematic review[J]. Ann Surg, 2024.
[17]
Kamal TR, Tyraskis A, Ghattaura H, et al. Synthetic versus biological patches for CDH: a comparison of recurrence rates and adverse events, systematic review, and meta-analysis[J]. Eur J Pediatr Surg, 2023, 33(3): 198-209.
[18]
Gong J, Qiao K, Wang Z, et al. Demonstration of an inconspicuous right diaphragmatic hernia in a blunt trauma patient using CT multi-planar reformation[J]. Quant Imaging Med Surg, 2011, 1(1): 44-45.
[19]
Panda A, Kumar A, Gamanagatti S, et al. Traumatic diaphragmatic injury: a review of CT signs and the difference between blunt and penetrating injury[J]. Diagn Interv Radiol, 2014, 20(2): 121-128.
[20]
Konstantinidi A, Liakou P, Kopanou Taliaka P, et al. Congenital diaphragmatic eventration in the neonatal period: systematic review of the literature and report of a rare case presenting with gastrointestinal disorders[J]. Pediatr Rep, 2023, 15(3): 442-451.
[21]
Park M, Jeong SH, Jung EJ, et al. Laparoscopic surgery applying an endostaple and mesh for adult diaphragmatic eventration[J]. Ann Thorac Surg, 2021, 111(2): e81-e83.
[22]
Li XS, He SQ, Chen XG. Diffuse neurofibroma of the chest and abdominal wall invading the diaphragm leads to diaphragmatic eventration: case report[J]. BMC Surg, 2021, 21(1): 258.
[23]
Hoskovec D, Hořejš J, Krška Z, et al. Diaphragmatic liver herniation after radiofrequency ablation of a secondary liver tumor[J]. Diagnostics(Basel), 2023, 14(1): 26.
[24]
Hertault H, Gandon A, Behal H, et al. Incidence and risk factors for diaphragmatic herniation following esophagectomy for cancer[J]. Ann Surg, 2021, 274(5): 758-765.
[25]
Zugayar D, Berkovits R, Tenenbaum A, et al. Post-operative anterior diaphragmatic hernias in children with Trisomy 21 after cardiac surgery[J]. Eur J Pediatr, 2023, 182(10): 4529-4535.
[26]
El-Magd EA, Elgeidie A, Abbas A, et al. Laparoscopic approach in the management of diaphragmatic eventration in adults: gastrointestinal surgical perspective[J]. Updates Surg, 2024, 76(2): 555-563.
[27]
Tatsumi A, Watanabe F, Adachi K, et al. Thoracoscopic plication for congenital diaphragmatic eventration in an adult[J]. Kyobu Geka, 2021, 74(11): 930-933.
[1] 马永钰, 杨仕武, 王舒钰, 陈君如, 曹辛, 洪伟, 罗忠明, 温瑷菡, 高云鹏, 陈健, 吴骏. 不同术式治疗婴儿食管裂孔疝的疗效分析[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(01): 25-31.
[2] 徐慧姣, 陈佳俊, 赖冠宇, 蒋琴, 马俊梅, 侯昉, 刘文英, 徐冰. 先天性食管裂孔疝患儿临床诊疗研究[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(01): 32-38.
[3] 宋连奎, 王建成, 王竹林, 王春生, 木洪伟, 季洪阁. TAPP和TEP治疗腹股沟疝临床效果比较[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 445-447.
[4] 曹桢, 刘子文. 医用胶在腹股沟疝中的临床研究进展[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 173-177.
[5] 陈传勤, 张凯, 单世涵, 陶亮, 傅巧美. 腹壁巨大切口疝修补术后早期疼痛的危险因素分析[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 178-183.
[6] 陈志升, 司仙科, 吴卫东, 李森, 杨佳华, 李炜, 郑侃, 于昆, 罗晓睿, 葛卫红. 耻脐入路单孔腹腔镜后鞘后技术在脐疝修补术中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 184-188.
[7] 宋延冰. 腹腔镜手术方式在嵌顿性腹壁疝中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 189-191.
[8] 李海风, 战俊, 滕世岗, 尹鹏, 刘忠诚. 改良套扎法在腹腔镜完全腹膜外疝修补术中关闭腹膜破裂的临床应用[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 192-196.
[9] 李斌, 康欣, 宋应寒, 雷文章. 完全腔镜下腹直肌后修补术治疗产后腹直肌分离经验分享[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 208-213.
[10] 郭建丽, 珠娜, 宋飞, 柴国东. 七氟烷吸入复合瑞芬太尼麻醉在小儿腹腔镜疝修补术中的效果[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 223-227.
[11] 刘伟, 丁晓寒, 邹振玉, 王景媛, 向承红. 精细化管理对腹腔镜下腹股沟疝日间手术运行效率的影响[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 234-237.
[12] 李绍杰, 谢奇峰, 李绍春, 杨子昂, 黄永刚, 陈吉彩, 杜舟, 王平, 张剑, 唐健雄. 复合基底膜生物补片应用于腹股沟疝Lichtenstein修补术的随机、对照、多中心临床研究[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 132-138.
[13] 孙义元, 马洪升, 雷文章, 宋应寒. 日归手术管理模式下疝修补术的加速康复实践分析[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(01): 37-41.
[14] 满艺, 李宝山, 王荫龙. 机器人腹股沟疝修补术的现状与进展[J]. 中华腔镜外科杂志(电子版), 2024, 17(01): 62-64.
[15] 苑乐添, 王艺霖, 沈子剑, 闫呈新. 血清GDF15、sB7-H1联合多层螺旋CT灌注成像技术对胃癌患者淋巴结转移的诊断价值[J]. 中华消化病与影像杂志(电子版), 2024, 14(01): 62-66.
阅读次数
全文


摘要