目的

探究MRI 对腹股沟疝修补术后患者早期手术并发症的评估价值。

方法

选取2019 年1 月至2023 年1 月于成都市双流区第一人民医院·四川大学华西空港医院80 例行腹腔镜下腹股沟疝修补术治疗且术后早期出现不良症状的患者为研究对象，术后1 个月内对各种不适症状患者行MRI 检查，评估MRI 对患者术后并发症的检出情况并分析各并发症的MRI 特征。

结果

80 例患者经穿刺或手术探查证实有55 例存在术后并发症，25 例无术后并发症，MRI 诊断术后并发症阳性57 例，阴性23 例，其中漏诊4 例，误诊6 例，诊断灵敏度为92.72%，特异度为76.00%，准确度为87.50%，阳性预测值为89.47%，阴性预测值为82.61%，Kappa 值为0.703。57 例并发症阳性患者中共检出病灶77 个，其中19 个（24.68%）为局部伤口积液，包括4 个脂肪液化，MRI 示腹壁脂肪层T1WI 信号降低；5 个血肿（补片上方血肿2 个，补片下方血肿3 个），血清肿10 个，MRI 表现为残余疝囊水肿、精索与重建内环口粘连；19 个局部伤口积液中9 例经穿刺治疗并证实诊断。5个（6.49%）切口感染并窦道形成。14 个（18.18%）MRI 诊断为阴囊壁水肿。16 个（20.78%）为精索增粗，包括9 个（11.69%）睾丸炎症，其中6 个显示睾丸单侧增大，3 个睾丸萎缩。6 个（7.79%）补片周围积液，MRI 显示积液分布于补片与腹前外侧之间。8 个（10.39%）复发疝经手术证实7 个诊断正确，1 个为腹股沟蜂窝织炎，误诊为复发疝。

结论

MRI 能够清晰显示腹股沟及其边缘区域深层结构的解剖信息，对早期术后并发症的诊断具有良好的应用价值。

Objective

To explore the evaluation value of magnetic resonance imaging (MRI) on early postoperative complications in patients undergoing inguinal hernia repair.

Methods

Eighty patients who underwent laparoscopic inguinal hernia repair and had early postoperative adverse symptoms in the First People's Hospital of Shuangliu District, Chengdu, Sichuan University, West China Airport Hospital and had early postoperative adverse symptoms were selected as the study subjects. MRI examination was performed on the patients with various discomfort symptoms within 1 month after surgery to evaluate the detection of postoperative complications and analyze the MRI characteristics of each complication.

Results

Among the 80 patients, 55 had postoperative complications by puncture or surgical exploration and 25 had no postoperative complications. MRI diagnosis of postoperative complications was positive in 57 patients and negative in 23 patients, of which 4 patients were missed and 6 patients were misdiagnosed. The diagnostic sensitivity was 92.72%, the specificity was 76.00%, the accuracy was 87.50%, and the positive predictive value was 89.47%, the negative predictive value was 82.61%, and the Kappa value was 0.703. A total of 77 lesions were detected in 57 patients with positive complications, of which 19 (24.68%) were local wound effusion. T1WI signal decreased in 4 abdominal fat layers, which was diagnosed as fat liquefaction by MRI; There were 5 hematoma (2 above the mesh, 3 below the mesh) and 10 seroma. MRI showed residual hernia sac edema and adhesion between spermatic cord and reconstructed internal ring opening. Among 19 local wound effusion, 9 were treated by puncture and confirmed diagnosis. Five (6.49%) were incisional infection with sinus tract formation. Scrotal wall edema was diagnosed in 14 lesions (18.18%) by MRI.Sixteen (20.78%) had spermatic cord thickening, and 9 (11.69%) had testicular inflammation, including 6 showed unilateral enlargement of testis and 3 had testicular atrophy. There were 6 lesions (7.79%) with effusion around the meshes and MRI showed that the effusion was distributed between the mesh and the anterolateral abdomen. Of the [8 (10.39%) recurrent hernias, 7 were correctly diagnosed by surgery, and 1 was inguinal cellulitis which was misdiagnosed as recurrent hernia.

Conclusion

MRI can clearly display the anatomical information of deep structure of the groin and its marginal region, and has good application value in the diagnosis of early postoperative complications.