• 四川大學(xué)華西醫(yī)院放射科（成都，610041）;

【摘要】　目的　 探討閉孔疝的CT表現(xiàn)，以提高對(duì)其疾病的診斷水平。　方法　 回顧性分析2009年10月-2010年9月收治的經(jīng)手術(shù)或臨床資料證實(shí)的3例閉孔疝患者的CT影像學(xué)表現(xiàn)，觀察閉孔疝發(fā)生的位置、密度、形態(tài)、強(qiáng)化特征及繼發(fā)征象。　結(jié)果　 3例閉孔疝均為老年消瘦患者，CT檢查發(fā)現(xiàn)疝囊位于閉孔外肌與恥骨肌間疝出1例，閉孔外肌上、中束間疝出2例，所有疝出物均為腸管，表現(xiàn)為疝出部位囊性密度影，1例腸壁可見增厚、水腫，診斷為腸壁血運(yùn)障礙，及時(shí)行手術(shù)治療后預(yù)后良好。　結(jié)論　 CT檢查是閉孔疝有效的檢測(cè)手段，特別是對(duì)于不明原因腹痛合并腸梗阻的老年消瘦患者，CT檢查將有助于臨床確診。
【Abstract】　Objective　 To observe the manifestations of CT images of obturator hernia to improve the diagnosis of obturator hernia. 　Methods　 The CT images of three patients with obturator hernia confirmed by surgery or clinical data from October 2009 to September 2010 were retrospectively analyzed. The location, density, morphology, enhancement patterns and secondary signs were observed. 　Results　 Three patients with obturator hernia were elder and emaciated. The hernia sac located between the pectineus and obturator externus muscles in two patients, between the superior and medial fasciculi of the obturator externus muscle in one patient. All contents were small intestine, performed as a low-density mass in the location. One patient with thick and hydropic intestinal wall diagnosed as strangulated obturator hernia had a good prognosis after immediately laparotomy. 　Conclusion　 CT examine is an effective measure for obturator hernia, especially for elder and emaciated patients with intestine obstruction due to unknown reason. CT examine is helpful for the diagnosis.

引用本文： 陳新月,趙爽,劉榮波. 閉孔疝的CT表現(xiàn). 華西醫(yī)學(xué), 2010, 25(12): 2195-2198. doi: 復(fù)制

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2. 　Jorge CG, Manuel RD, Alexandro ED, et al. Incarcerated obturator hernia successfully treated by laparoscopy [J]. Surg Laparosc Endosc, 1998, 8(1): 71-73.
3. 　Ijiri R, Kanamaru H, Yokoyama H, et al. Obturator hernia: the usefulness of computed tomography in diagnosis [J]. Surgery, 1996, 119(2): 137-140.
4. 　Terada R, Ito S, Kidogawa H, et al. Obturator hernia: the usefulness of emergent computed tomography for early diagnosis [J]. J Emerg Med, 1999, 17(5): 883-886.
5. 　Standring S. Gray’s anatomy: the anatomical basis of clinical practice[M]. Elsevier: Churchill Livingstone, 2004: 1357-1362.
6. 　Skandalakis LJ, Androulakis J, Colborn GL, et al. Obturator hernia. Embryology, anatomy, and surgical applications [J]. Surg Clin North Am, 2000, 80(1): 71-84.
7. 　Skandalakis LJ, Skandalakis PN, Gray SW, et al. Obturator hernia [J]. Hernia, 1995, 4(2): 425-439.
8. 　Callaghan CJ, Whitaker RH. Obturator canal fat plug: a pre-hernia condition? [J]. Clin Anat, 2002, 15(4): 276-279.
9. 　Chu CW, Loftns WK, Somers SS, et al. Obturator hernia diagnosed by computed tomography [J]. Aust NZJ Surg, 1996, 67(8): 737-738.
10. 　Kammori M, Mafune K, Hirashima T, et al. Forty-three cases of obturator hernia[J]. Am J Surg, 2004, 187(4): 549-552.
11. 　Terada R, Ito S, Kidogawa H , et al. Obturator hernia : The usefulness of emergent computed tomography for early diagnosis[J]. J Emerg Educine, 1999, 17 (5): 883.
12. 　Nishina M, Fujii C, Ogino R, et al. Properative diagnosis of obturator hernia by computed tomography in six patients[J]. J Emerg Med, 2001, 20(3): 277.
13. 　吳先麟, 蔡魏, 張光全, 等. 閉孔疝的術(shù)前診斷和手術(shù)治療14例臨床分析[J]. 局解手術(shù)學(xué)雜志, 2006, 15(2): 96-97.
14. 　Cali RL, Pitsch RM, Blatchford GJ, et al. Rare pelvic floor hernias: report of a case and review of the literature [J]. Dis Colon Rectum, 1992, 35(6): 604-612.
15. 　Yip AW, AhChong AK, Lam KH. Obturator hernia: a continuing diagnostic challenge [J]. Surgery, 1993, 113(3): 266-269.
16. 　Naude G, Bongard F. Obutartor hernia is an unsuspected diagnosis [J]. Am J Surg, 1997, 174(1): 72-75.
17. 　謝輝, 于海東, 桑文. 閉孔疝的早期診治13例分析[J]. 昆明醫(yī)學(xué)院學(xué)報(bào), 2009, 30(12): 131-133.
18. 　Nishina M, Fujii C, Ogino R, et al. Preoperative diagnosis of obturator hernia by computed tomography in six patients[J]. J Emerg Med, 2001, 20(3): 277-280.
  1. 1. 　Ziegler DW, Rhoads JE. Obturator hernia needs a laparotomy, not a diagnosis [J]. Am J Surg. , 1995, 170(1): 67-68.
  2. 2. 　Jorge CG, Manuel RD, Alexandro ED, et al. Incarcerated obturator hernia successfully treated by laparoscopy [J]. Surg Laparosc Endosc, 1998, 8(1): 71-73.
  3. 3. 　Ijiri R, Kanamaru H, Yokoyama H, et al. Obturator hernia: the usefulness of computed tomography in diagnosis [J]. Surgery, 1996, 119(2): 137-140.
  4. 4. 　Terada R, Ito S, Kidogawa H, et al. Obturator hernia: the usefulness of emergent computed tomography for early diagnosis [J]. J Emerg Med, 1999, 17(5): 883-886.
  5. 5. 　Standring S. Gray’s anatomy: the anatomical basis of clinical practice[M]. Elsevier: Churchill Livingstone, 2004: 1357-1362.
  6. 6. 　Skandalakis LJ, Androulakis J, Colborn GL, et al. Obturator hernia. Embryology, anatomy, and surgical applications [J]. Surg Clin North Am, 2000, 80(1): 71-84.
  7. 7. 　Skandalakis LJ, Skandalakis PN, Gray SW, et al. Obturator hernia [J]. Hernia, 1995, 4(2): 425-439.
  8. 8. 　Callaghan CJ, Whitaker RH. Obturator canal fat plug: a pre-hernia condition? [J]. Clin Anat, 2002, 15(4): 276-279.
  9. 9. 　Chu CW, Loftns WK, Somers SS, et al. Obturator hernia diagnosed by computed tomography [J]. Aust NZJ Surg, 1996, 67(8): 737-738.
  10. 10. 　Kammori M, Mafune K, Hirashima T, et al. Forty-three cases of obturator hernia[J]. Am J Surg, 2004, 187(4): 549-552.
  11. 11. 　Terada R, Ito S, Kidogawa H , et al. Obturator hernia : The usefulness of emergent computed tomography for early diagnosis[J]. J Emerg Educine, 1999, 17 (5): 883.
  12. 12. 　Nishina M, Fujii C, Ogino R, et al. Properative diagnosis of obturator hernia by computed tomography in six patients[J]. J Emerg Med, 2001, 20(3): 277.
  13. 13. 　吳先麟, 蔡魏, 張光全, 等. 閉孔疝的術(shù)前診斷和手術(shù)治療14例臨床分析[J]. 局解手術(shù)學(xué)雜志, 2006, 15(2): 96-97.
  14. 14. 　Cali RL, Pitsch RM, Blatchford GJ, et al. Rare pelvic floor hernias: report of a case and review of the literature [J]. Dis Colon Rectum, 1992, 35(6): 604-612.
  15. 15. 　Yip AW, AhChong AK, Lam KH. Obturator hernia: a continuing diagnostic challenge [J]. Surgery, 1993, 113(3): 266-269.
  16. 16. 　Naude G, Bongard F. Obutartor hernia is an unsuspected diagnosis [J]. Am J Surg, 1997, 174(1): 72-75.
  17. 17. 　謝輝, 于海東, 桑文. 閉孔疝的早期診治13例分析[J]. 昆明醫(yī)學(xué)院學(xué)報(bào), 2009, 30(12): 131-133.
  18. 18. 　Nishina M, Fujii C, Ogino R, et al. Preoperative diagnosis of obturator hernia by computed tomography in six patients[J]. J Emerg Med, 2001, 20(3): 277-280.