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目的评价 CT 测量食管裂孔宽度的临床意义并认识食管裂孔疝(EHH)在多层螺旋CT(MSCT)上的表现。方法(1)在140例成人的胸、腹部正常 MSCT 图像上,测量了代表食管裂孔宽度的膈肌脚间距,并作统计学分析;(2)搜集56例经上消化道造影或胃镜诊断为食管裂孔疝的胸、腹部 MSCT 资料,测量了患者的膈肌脚间距,并回顾性分析了食管裂孔疝的 CT 表现。结果 (1)140例成人正常膈肌脚间距平均值为(13.44±4.41)mm,并且随年龄增加而增大,其中≤59岁(80例)和≥60岁(60例)者膈肌脚间距平均值分别为(11.03±2.10)mm 和(16.67±4.64)mm,两者间的差异有统计学意义(t=8.762,P<0.01)。成人正常膈肌脚间距的上界为21 mm。(2)56例 EHH的膈肌脚间距测量平均值为(29.50±9.71)mm,与正常膈肌脚间距之间的差异有统计学意义(t=21.684,P<0.01),83.93%(47例)EHH 的膈肌脚间距均较正常上界为大。(3)56例 EHH 在 CT 上都表现为经食管裂孔进入后纵隔心后区内的假肿块或假结节影,其中53例(94.6%)为胃肠型,3例(5.4%)为非胃肠型。胃肠型者中,37例(69.8%)呈假肿块状影,大小16 mm×31 mm～88 mm×110 mm,16例(30.2%)呈直径<30 mm的假结节状软组织影。92.4% EHH 的疝囊内含有气体和(或)对比剂或液气平面,增强时疝囊壁与膈下胃壁一致强化。结论食管裂孔增大是发生 EHH 的前提和主要原因,在 EHH 的 CT 诊断上有重要意义。CT 还能从多方面显示 EHH 的全貌,有助于鉴别诊断及避免将 EHH 误诊为食管或胃的其他病变。
Objective To evaluate the clinical significance of measuring the width of esophageal hiatus by CT and to understand the performance of esophageal hiatal hernia (EHH) on multislice spiral CT (MSCT). Methods (1) The distance between the diaphragmatic muscles representing the width of esophageal foramina was measured on 140 normal adult MSCT images of the thorax and abdomen, and statistical analysis was performed. (2) Fifty-six cases of upper gastrointestinal tract Hiatal hernia thoracic and abdominal MSCT data were measured in patients with diaphragmatic foot spacing and retrospective analysis of esophageal hiatal hernia CT manifestations. Results (1) The average distance between the normal diaphragmatic muscles of 140 adults was (13.44 ± 4.41) mm and increased with age, of which, the average distance between diaphragmatic muscles of children aged ≤59 years (80 cases) and ≥60 years (60 cases) (11.03 ± 2.10) mm and (16.67 ± 4.64) mm, respectively. The difference between the two groups was statistically significant (t = 8.762, P <0.01). The upper limit of adult normal diaphragm foot space is 21 mm. (2) The average distance between diaphragmatic muscles of 56 cases of EHH was (29.50 ± 9.71) mm, and there was significant difference between them (P <0.01) and 83.93% (47 cases) EHH diaphragmatic foot spacing than the normal upper bound as large. (3) Fifty-six cases of EHH presented with false mass or false nodules in the posterior mediastinum area after trans-esophageal hiatus on CT, of which 53 (94.6%) were gastrointestinal and 3 (5.4%) were Non-gastrointestinal type. In the gastrointestinal type, 37 cases (69.8%) had pseudomembranous soft tissue with a size of 16 mm × 31 mm ~ 88 mm × 110 mm and 16 cases (30.2%) with a diameter of <30 mm. 92.4% EHH hernia sac contains gas and (or) contrast agent or liquid gas level, enhanced hernia wall consistent with the lower wall of the diaphragm under the diaphragm strengthen. Conclusion Increased esophageal hiatus is the prerequisite and main cause of EHH, which is of great significance in the diagnosis of EHH. CT also shows the whole picture of EHH in many aspects, which can help in differential diagnosis and avoid misdiagnosis of EHH as other lesions of the esophagus or stomach.