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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。
Objective: To investigate the value of CT and MRI in diagnosis and differential diagnosis of Grynfelt-Lesshaft’s herniation. Methods: Clinical and imaging data of 28 Grynfelt-Less-hanse hernia confirmed by operation or clinical follow-up in our hospital from August 2013 to December 2016 were retrospectively analyzed. 28 cases of all multi-slice spiral CT examination, 3 cases simultaneously MRI examination. Results: Among the 28 cases, 20 were males and 8 were females, ranging in age from 44 to 80 years (mean, 69.0 ± 3.5 years). 16 cases were unilateral (right side in 12 cases, left side in 4 cases), bilateral in 12 cases. CT and MRI manifestations of hernia in the Grynfelt-Lesshaft triangle (upper triangle) weakness: 11 or 12 ribs under the edge of the medial rectus abdominis medial, erector spinae, lumbar muscle outer edge of the bottom of the abdomen Transverse tendon formation, the top of the latissimus dorsi. The peritoneal and retroperitoneal tissues protrude subcutaneously into the lower back through the weakened zone to form round or flask-like lumps. This group of hernia into the triangle content of the area mostly for adipose tissue or combined with mesangial hernia out of the contents of the size and the hernia ring is not disproportionate. Hernia ring diameter of about 1.5 ~ 8.7 cm, hernia sac size 1.6 cm × 1.3 cm ~ 9.2 cm × 5.4 cm. CT and MRI images easily with the lateral posterior abdominal hernia, posterior abdominal wall bulging or pseudo-hernia, lipoma and other soft tissue tumors, hematoma and abscess identification. Conclusion: CT and MRI can clearly show the size of the Grynfelt-Lesshaft hernia ring, hernia contents, possible complications, weakness of the surrounding abdominal muscles and the extent of the defect, which can confirm the diagnosis and further exclude other lesions, which is worthy of application.