胃超声造影诊断食管裂孔疝的价值

摘要

Objective To summarize the features of esophageal hiatus hernia (EHH) on contrast-enhanced ultrasound (CEUS) and investigate the diagnostic value of CEUS in EHH.Methods A retrospective analysis of 88 EHH patients and 50 healthy controls was conducted with focus on their findings on CEUS.Results The structures of the cardiac and abdominal esophagus were clear in 50 healthy controls,and the esophageal hiatus diameters were (1.96±0.39) cm.In contrast,the cardiac and abdominal esophagus in EHH patients were unable to be identified in subdiaphragm region.The esophageal hiatus was wider with a diameter of (3.24±0.76) cm.The difference was statistically significant(t=2.36,P＜0.05).The hernia sacs were found in 78 EHH patients at rest.And the hernia sacs were present on the diaphragm in 10 EHH patients after pressure.The maximum diameter of hernia sac was 7.6 cm.The size of hernia sac may change with abdominal pressure.In sliding EHH patients,the sac wall was found to slide up and down the diaphragm.A mass was found on the wall in 2 patients.The B ring was present in 76 patients.For healthy controls in supine position,contrast-enhanced ultrasound showed that the gastric bottom and diaphragm were at dependent or horizontal position.The gastric bottom and diaphragm was upward in 73 patients.Conclusions The EHH has characteristic appearance on CEUS.It is easy to detect and diagnose EHH with CEUS,which has a diagnostic value in detection of space-occupying lesions in hernia sac.CEUS can be used for EHH screening.%目的总结食管裂孔疝(EHH)患者超声造影表现,探讨超声造影对EHH的诊断价值.方法 回顾性分析88例EHH患者的超声造影表现,并与50名健康人进行比较.结果 50名健康人贲门及腹段食管结构均清晰,食管裂孔直径为(1.96±0.39)cm,EHH患者膈下均不能探及腹段食管及贲门结构,食管裂孔直径为(3.24±0.76)cm,较健康人增宽,且差异有统计学意义(t=2.36,P＜0.05).78例EHH患者平静状态下膈可见疝囊,10例加压后出现膈上疝囊,疝囊直径最大7.6 cm,疝囊大小可随腹压变化,滑动性EHH患者可见囊壁于膈肌上下滑动,2例EHH患者可见囊壁占位.76例EHH患者可见B环.健康人平卧位左肋缘下斜切面超声造影示胃底横隔均处于下垂或水平状态,73例EHH患者可见胃底横隔上翘.结论 EHH患者超声造影表现有特点.超声造影易发现及诊断EHH,对疝囊占位亦有一定的诊断价值.超声造影可作为EHH的一种筛查手段.