探讨多层螺旋CT测量疝囊及腹腔容积技术在巨大食管裂孔疝临床治疗中的意义。

回顾性分析2015年6月至2016年2月，新疆维吾尔自治区人民医院收住的15例临床诊断为巨大食管裂孔疝患者的临床资料，均经64排螺旋CT腹腔扫描，通过三维重建技术进行疝囊及腹腔容积测量，并进行临床随访。

15例患者疝囊容积166.5～1 080.6 cm³，平均容积为(569.9±268.0)cm³。胸腔容积2 136.3～6 104.2 cm³，平均容积为(3 615.9±1 061.1)cm³。腹腔容积为4 436.9～12 630.2 cm³，平均容积为(9 540.2±2 618.9)cm³。疝囊容积/腹腔容积比值2.3%～19.6%，平均(6.69%±4.6%)。体质指数为19.9～41 kg/cm²，平均(27.1±5.83)kg/cm²。食管裂孔宽度2.66～5.45 cm，平均疝口直径值(3.89±0.85)cm。15例临床随访，10例经术前评估，腹腔镜手术治疗，治愈出院；1例出现术后疝复发，合并肺部感染，胸腔积液；1例出现术后感染，呼吸衰竭；1例因高龄未行手术；1例体重过重，建议减轻体重后，进一步治疗；1例自动出院。

多层螺旋CT平面重组技术可以清楚显示食管裂孔疝膈肌上疝囊形态，内容物以及周围毗邻关系，可以测量疝口的大小，疝囊的容积及腹腔容积，为食管裂孔疝临床分类以及临床治疗决策提供依据。巨大食管裂孔疝手术并发症发生率较高，通过疝囊/腹腔容积测量评价手术危险程度，可以避免严重手术并发症的发生。

To explore the significance of multislice spiral CT hernia sac and intraperitoneal volume measurement in clinical treatment of giant hiatus hiatal hernia.

The clinical data of 15 cases that were diagnosed as esophageal hiatus in People′s Hospital of Xinjiang Uygur Autonomous Region from June 2015 to February 2016 were collected.The abdominal scan was performed by 64 slice spiral CT, and the volume of the hernia sac and abdominal cavity were measured by three-dimensional reconstruction technique.

15 patients′sac minimum volume was about 166.5 cm³, a maximum of them was 1 080.6 cm³, average volume was(569.9±268.0)cm³.Pleural minimum volume was 2 136.3 cm³, the maximum was 6104.2 cm³, average volume was(3 615.9±1 061.1)cm³.Intraperitoneal volume minimum was 4 436.9 cm³, the maximum was 12 630.2 cm³, and average volume was(9 540.2±2 618.9)cm³.Sac volume/volume ratio of the abdominal cavity, the maximum value was 19.6%, the minimum value was 2.30%, and the average was(6.69%±4.6%). A hernia opening maximum diameter was 5.45 cm, the minimum was 2.66 cm, the average value of the hernia orifice diameter was(3.89±0.85)cm.Clinical follow-up of 15 cases and 10 cases of preoperative evaluation, surgical treatment, cured; 1 patient had postoperative hernia recurrence, pulmonary infection, pleural effusion; 1 case of postoperative infection, respiratory failure; 1 patient with advanced age did not surgery; 1 case of overweight, weight loss was recommended after further treatment; 1 patient discharged.

Multislice spiral CT planar reconstruction technology could clearly show the esophageal hiatal hernia diaphragmatic hernia sac shape, content and the surrounding adjacent relationship.The size of hernia, hernia sac volume and abdominal volume could be measured, for the clinical classification of esophageal hiatal hernia and clinical treatment.And a basis for decision-making; a huge incidence of surgical complications of hiatal hernia hiatus could be provided through the hernia sac/peritoneal volume measurement to assess the degree of surgical risk and avoid serious surgical complications.