基于多层螺旋CT（MSCT）影像学特征与高频超声鉴别成人腹股沟斜疝、直疝的临床价值。

回顾性分析2020年1月至2024年12月榆林市中医医院收治的腹股沟区出现包块的125例患者的临床资料，并行疝腹腔镜修补术。以外科疝腹腔镜修补术探查结果为金标准，所有患者均接受MSCT检查和高频超声检查。分析MSCT、高频超声对腹股沟疝的诊断价值；分析MSCT、高频超声对腹股沟斜疝、直疝的诊断价值；比较腹股沟斜疝、直疝的MSCT位置特点、影像学征象；比较腹股沟斜疝、直疝高频超声影像学征象；比较腹股沟斜疝、直疝疝内容物检出情况。

MSCT诊断腹股沟疝灵敏度、特异度分别为97.79%、80.00%，kappa值为0.652；高频超声诊断腹股沟疝灵敏度、特异度分别为96.32%、80.00%，kappa值为0.551。MSCT用于斜疝诊断，灵敏度97.00%、特异度94.44%，kappa值为0.906，用于直疝诊断，灵敏度94.44%、特异度97.00%，kappa值为0.906。高频超声诊断斜疝灵敏度、特异度分别为92.00%、88.89%，kappa值为0.781，诊断直疝灵敏度、特异度分别为88.89%、92.00%，kappa值为0.781。腹股沟斜疝混杂密度或为囊实性，均分布于腹股沟韧带前侧，位于腹壁下动脉外侧，没有新月征、股三角填塞表现；直疝均分布于腹股沟韧带前侧，位于腹壁下动脉内侧，没有股三角填塞表现，多见外侧新月征。斜疝疝囊位于腹壁下动脉起始段外侧，疝环直径及形态差异较大；直疝可见疝囊位于腹壁下动脉内侧，局部腹壁未发生显著改变，肠壁层次清晰，无明显疝囊颈，部分患者疝囊腔中可探及少量液性暗区，疝环位于腹壁下血管内侧，肠壁有少量的彩色血流信号。斜疝内容物占比依次为肠管、大网膜、卵巢、积液、腹腔内脂肪、膀胱；直疝内容物占比依次为肠管、腹腔内脂肪、大网膜、积液、卵巢、脂肪、膀胱；经Bonferroni校正（校正后显著性水准为P<0.008 3），2组在所有内容物的检出率上，差异均无统计学意义（均P>0.008 3）。

基于MSCT影像学特征与高频超声鉴别成人腹股沟斜疝、直疝均具有重要临床价值。MSCT可通过确认是否存在特异性影像学征象，并结合疝囊颈与腹壁下动脉的关系，为腹股沟疝的分型提供依据。高频超声可实时动态评估疝内容物的可复性，对于临床分型具有重要指导意义。

To evaluate the clinical value of multi-slice spiral CT (MSCT) imaging features and high-frequency ultrasound in differentiating indirect and direct inguinal hernias in adults.

Clinical data of 125 patients presenting with an inguinal mass and admitted to Yulin Hospital of Traditional Chinese Medicine between January 2020 and December 2024 were retrospectively analyzed. All patients underwent laparoscopic hernia repair. Intraoperative findings during laparoscopic exploration were used as the reference standard. All patients received MSCT and high-frequency ultrasonography. The diagnostic performance of MSCT and high-frequency ultrasonography for inguinal hernia was evaluated, as well as their performance in diagnosing indirect and direct inguinal hernias. MSCT location characteristics and imaging signs, high-frequency ultrasonographic findings, and the detection of hernia contents were compared between indirect and direct inguinal hernias.

The sensitivity and specificity of MSCT in diagnosing inguinal hernias were 97.79% and 80.00%, respectively, with a kappa value of 0.652. The sensitivity and specificity of high-frequency ultrasound in diagnosing inguinal hernias were 96.32% and 80.00%, respectively, with a kappa value of 0.551. For the diagnosis of indirect hernias, MSCT had a sensitivity of 97.00% and a specificity of 94.44%, with a kappa value of 0.906; for the diagnosis of direct hernias, MSCT had a sensitivity of 94.44% and a specificity of 97.00%, with a kappa value of 0.906. High-frequency ultrasound had a sensitivity of 92.00% and a specificity of 88.89% for diagnosing indirect hernias, with a kappa value of 0.781, and a sensitivity of 88.89% and a specificity of 92.00% for diagnosing direct hernias, with a kappa value of 0.781. Indirect inguinal hernias presented with mixed density or were cystic-solid, all distributed on the anterior side of the inguinal ligament and lateral to the inferior epigastric artery, without a crescent sign or filling of the femoral triangle. Direct hernias were all distributed on the anterior side of the inguinal ligament and medial to the inferior epigastric artery, without filling of the femoral triangle, and often with a lateral crescent sign. The indirect hernia sac was located lateral to the origin of the inferior epigastric artery, and the diameter and shape of the hernia ring varied greatly. The direct hernia sac was located medial to the inferior epigastric artery, with no significant changes in the local abdominal wall, clear intestinal wall layers, no obvious hernia sac neck, and a small amount of fluid dark area could be detected in the hernia sac cavity of some patients. The hernia ring was located medial to the inferior epigastric vessels, and there was a small amount of color blood flow signal in the intestinal wall. The proportions of contents in indirect hernias were, in descending order: intestinal canal, greater omentum, ovary, effusion, intra-abdominal fat, and bladder. The proportions of contents in direct hernias were, in descending order: intestinal canal, intra-abdominal fat, greater omentum, effusion, ovary, fat, and bladder. After Bonferroni correction (corrected significance level of P<0.0083), there were no statistically significant differences in the detection rates of all contents between the two groups (all P>0.0083).

Both MSCT imaging features and high-frequency ultrasound have important clinical value in differentiating indirect and direct inguinal hernias in adults. MSCT can provide a basis for the classification of inguinal hernias by confirming the presence of specific imaging signs and combining the relationship between the hernia sac neck and the inferior epigastric artery. High-frequency ultrasound can dynamically assess the reducibility of hernia contents in real time, which is of great guiding significance for clinical classification.