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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/OL]. 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/OL]. 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。
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