医学腹外疝影像学诊疗PPT培训课件

,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,腹外疝影像学诊疗,疝,指任何脏器或组织，由正常部位通过人体薄弱点、缺损或间隙进入另一部位。最多见于腹部。,刘福岭 主编.现代医学辞典.济南：山东科学技术出版社.1990.第485页.,腹疝,定义：腹腔内任何脏器或组织，由于各种原因，离开原来位置，经由先天存在的或后天形成的裂孔或间隙、薄弱区进另一部位称为腹疝。,腹疝,腹外疝,腹内疝,腹外疝的分类,腹股沟疝,股疝,脐疝,切口疝,白线疝,半月线疝,膈疝,腰疝,闭孔疝,会阴疝,腹外疝,按照发生部位分为以下10类,腹外疝的分类,可复性疝,绞窄性疝,嵌顿疝,滑动疝,难复性疝,腹外疝,腹外疝根据临床特点,腹外疝诊断、鉴别诊断,腹股沟斜疝,腹股沟直疝,闭孔疝,股疝,腹外疝,腹股沟斜疝,从腹壁下动脉外侧的腹股沟内环突出，沿腹股沟管向内下前方斜行，再穿过腹股沟管外环形成的疝块，并可下降至阴囊（女性可至大阴唇），是最常见的一种疝。男性较女性好发，右侧较左侧好发。,腹股沟区解剖,Herniated large bowel in a 55-year-old man with hepatocellular carcinoma.,Bhosale P R et al.Radiographics 2008;28:819-835,2008 by Radiological Society of North America,腹股沟区横断面解剖,腹股沟斜疝,腹股沟斜疝,腹股沟斜疝,腹股沟直疝,定义：自直疝三角区（Hesselbach）突出的疝，称腹股沟直疝，好发于中老年人和体弱者，与直疝三角区的肌肉和筋膜发育不全、肌肉萎缩退化以及腹内压力升高等诸多因素有关。,腹股沟直疝,腹股沟直疝,腹股沟直疝,闭孔疝,闭孔疝（obturator hernia）是指腹腔内脏器经过髋骨闭孔突出于股三角区而形成，系后天获得性疝，多见于老年体格瘦弱者，7080岁为高发年龄，尤其多见于经产或多产老年妇女。,发病原因：与老年体弱、营养不良及骨盆宽大和闭孔较大有关。,闭孔大体解剖,临床特异征象,Howship-Romberg征 正常情况下，闭孔管内除有闭孔神经和血管通过外，其余空间为脂肪组织所填充。当闭孔疝发生时，疝囊及腹腔内容物被挤入一个狭小、坚硬的管道内，即出现闭孔神经受压症状。临床上表现为腹股沟区及大腿内侧的刺痛、麻木、酸胀感，并向膝内侧放射，当咳嗽，伸腿外展、外旋时，由于内收肌对闭孔外肌的牵拉，可使闭孔神经受压加重，而至疼痛加剧，反之则减轻，称之为Howship-Romberg征。此征在闭孔疝中的发生率约为20.2%-100%不等,CT表现,未嵌顿时可见闭孔肌和耻骨肌之间有低密度影，肿块表现为较对侧明显不同的含气密度及肠管扩张；嵌顿后可见肠影从闭孔内侧进入闭孔，且该闭孔内肠影以上的肠管有肠梗阻征象，即可诊断闭孔疝。,术中表现,CT、术中表现,股疝,股疝,股疝（femoral hernia）是指经股环、股管并自卵圆窝突出的疝，多为后天获得性，先天性股疝极其罕见。其发病与股环较宽、妊娠、肥胖、结缔组织退变、腹内压升高等因素有关，以中年以上妇女多见，约占腹外疝的5%。右侧好发,股管解剖,股疝,Extent of hernia sac was evaluated visually based on relationship between hernia sac and pubic tubercle on axial CT images.,Suzuki S et al.AJR 2007;189:W78-W83,2007 by American Roentgen Ray Society,Compression of femoral vein on CT scans through acetabula and pubic symphysis in 66-year-old woman.,Suzuki S et al.AJR 2007;189:W78-W83,2007 by American Roentgen Ray Society,股疝,股疝,腹股沟韧带,腹股沟区疝鉴别诊断,斜疝,直疝,发生率,94%,6%,好发年龄,儿童及青壮年,老年,突出路径,经腹股沟管突出,经Hesselbach三角突出,疝块外形,椭圆形或梨形，基底细,半球形，基底宽,疝内容物还纳后压迫内环,疝块不突出,疝块仍突出,疝囊和精囊的关系,精索在疝囊后方,精索在疝囊前外侧,疝囊颈和腹壁下动脉的关系,疝囊颈在其外侧,疝囊颈在其内侧,嵌顿情况,易,不易,上述腹外疝鉴别诊断,腹股沟疝,闭孔疝,股疝,疝块位置,腹股沟韧带上方，耻骨结节内上,耻骨肌、闭孔外肌间,腹股沟韧带下方，耻骨结节外下,股静脉受压,很少见,很常见,与精索关系,斜疝与精索紧密相邻,反之,突出路径,经腹股沟管或Hesselbach三角,经闭孔管于耻骨肌深层、股三角的下端突出,经股管疝入，并于股静脉内侧的卵圆窝突出,谢谢大家,参考文献,1 Aguirre D A,Santosa A C,Casola G,et al.Abdominal wall hernias:imaging features,complications,and diagnostic pitfalls at multi-detector row CTJ.Radiographics,2005,25(6):1501-1520.,2 Suzuki S,Furui S,Okinaga K,et al.Differentiation of femoral versus inguinal hernia:CT findingsJ.AJR Am J Roentgenol,2007,189(2):W78-W83.,3 Toms A P,Dixon A K,Murphy J M,et al.Illustrated review of new imaging techniques in the diagnosis of abdominal wall herniasJ.Br J Surg,1999,86(10):1243-1249.,4 Shadbolt C L,Heinze S B,Dietrich R B.Imaging of groin masses:inguinal anatomy and pathologic conditions revisitedJ.Radiographics,2001,21 Spec No:S261-S271.,5 Robinson P,White L M,Agur A,et al.Obturator externus bursa:anatomic origin and MR imaging features of pathologic involvementJ.Radiology,2003,228(1):230-234.,6 Bhosale P R,Patnana M,Viswanathan C,et al.The inguinal canal:anatomy and imaging features of common and uncommon massesJ.Radiographics,2008,28(3):819-835,913.,7 Yoon W,Kim J K,Jeong Y Y,et al.Pelvic arterial hemorrhage in patients with pelvic fractures:detection with contrast-enhanced CTJ.Radiographics,2004,24(6):1591-1605,1605-1606.,8 Zhang H,Cong J C,Chen C S.Ileum perforation due to delayed operation in obturator hernia:a case report and review of literaturesJ.World J Gastroenterol,2010,16(1):126-130.,9 Cherian P T,Parnell A P.The diagnosis and classification of inguinal and femoral hernia on multisection spiral CTJ.Clin Radiol,2008,63(2):184-192.,10 Cherian P T,Parnell A P.The diagnosis and classification of inguinal and femoral hernia on multisection spiral CTJ.Clin Radiol,2008,63(2):184-192.,