CT及MRI对Grynfelt-Lesshaft’s疝的诊断价值

目的:探讨CT、MRI在Grynfelt-Lesshaft's疝诊断及鉴别诊断中的价值。方法:回顾性分析2013年8月至2016年12月我院经手术或临床随访证实的28例Grynfelt-Lesshaft疝的临床及影像学资料。28例全部行多层螺旋CT检查,3例同时行MRI检查。结果:28例中,男20例,女8例,年龄44~80岁(平均(69.0±3.5)岁)。单侧16例(右侧12例,左侧4例),双侧12例。CT及MRI上表现疝位于Grynfelt-Lesshaft三角(腰上三角)薄弱区:第11或12肋下缘下,腹内斜肌内缘内侧,竖脊肌、腰方肌的外缘,底部为腹横肌腱膜形成,顶部为背阔肌。腹腔、腹膜后组织经该薄弱区向腰背部皮下突出形成类圆形或烧瓶样肿块。本组疝入缺损三角区内容物多为脂肪组织或合并系膜,疝出内容物的大小与疝环多不成比例。疝环直径大小约1.5~8.7 cm,疝囊大小1.6 cm×1.3 cm~9.2 cm×5.4 cm。CT及MRI影像学上易于与侧后腹壁疝、侧后腹壁膨出或假性疝、脂肪瘤等软组织肿瘤、血肿和脓肿等鉴别。结论:CT及MRI能清晰显示Grynfelt-Lesshaft疝疝环的大小、疝内容物、可能的并发症、周围腹壁肌群薄弱及缺损程度,可明确诊断及进一步排除其他病变,值得应用。 

Diagnostic Value of CT and MRI in Grynfelt-Lesshaft's Hernia

Objective: To study the diagnosis and differential diagnosis values of CT and MRI in Grynfelt-Lesshaft's hernia. Methods: From August 2013 to December 2016,in our hospital, the data of clinical and imagings of 28 patients with Grynfelt-Lesshaft's hernia confirmed by operation or clinical were retrospectively analyzed. All patients underwent multi-slice spiral CT examination, and three of them also underwent MRI examination. Results: Of all the 28 patients, 20 were male, 8 were female, age: 44 to 80 years (average 69.04 ±3.5 years). Unilateral in 16 cases (right side in 12 cases, left side in 4 cases), bilateral in 12 cases. On the imagings of CT and MRI, the hernia located in the Grynfelt-Lesshaft triangular (superior lumbar triangular) region, which his boundaries were formed superiorly by the 11th or 12th thoracic rib, medially by the erector spinae muscle group, laterally by the internal oblique muscle. The floor of this triangle was formed by aponeurosis of the transversalis muscle, and the roof was formed by the latissimus dorsi muscle. CT or MRI showed oval or flask shaped mass of extraperitioneal fat with or without peritoneum and visceral contents protruded through the defecting fascia floor into lumbar triangle, and the size of the hernia contents was out of proportion with the hernia ring.Hernia ring in diameter ranged from 1.5 to 8.7cm,and the hernia sac size ranged from 1.6 cm×1.3cm to 9.2cm×5.4 cm. Imagings of CT and MRI were easy to differentiate Grynfelt hernia from other lesions such as outborrd and posterior abdominal wall hernia, bulging or pseudohernia abdominal wall hernia, lipoma and other soft tissue tumors, hematoma and abscess. Conclusion: CT and MRI can clearly show the ring size of Grynfelt-Lesshaft's hernia hernia, the hernia contents and possible complications, the weak and defect degree of the abdominal wall muscles around. CT and MRI are helpful for diagnosis of Grynfelt-Lesshaft's hernia and differentiation from other diseases, and worthy of application.