典型病例•脐疝的超声表现
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">脐疝的超声表现 </span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">刘耀利 </span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">广西医科大学<span style="color: black;">第1</span><span style="color: black;">附庸</span>医院超声医学科</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">张X</span>X，男，8<span style="color: black;">月，因“脐部</span></span><span style="color: black;">肿物2周”来诊。<strong style="color: blue;">查体：</strong>脐部可触及一个隆起性肿物，质软、<span style="color: black;">没</span>压痛，按压肿物可使之回纳</span><span style="color: black;">，局部皮肤<span style="color: black;">没</span>颜色改变</span><span style="color: black;">。余<span style="color: black;">没</span><span style="color: black;">显著</span>阳性体征。<strong style="color: blue;">超声<span style="color: black;">检测</span>：</strong>脐部探及一疝囊样结构，</span><span style="color: black;"><span style="color: black;">体积</span>约1.6×0.9cm，</span><span style="color: black;">边界清，形态不规则，内可见肠管样回声，</span><span style="color: black;">肠壁<span style="color: black;">没</span><span style="color: black;">显著</span>水肿、增厚，</span><span style="color: black;">与腹腔深方肠管相连，加压探头时疝内容物可进入腹腔，患儿<span style="color: black;">呼气</span>时可见疝囊样结构及内容物周期性膨出、回纳，</span><span style="color: black;">线阵探头扫查可观察到疝口，</span><span style="color: black;">疝囊样结构及内容物</span><span style="color: black;">在疝口处滑动顺畅，<span style="color: black;">体积</span>随腹腔压力<span style="color: black;">出现</span>变化。</span><strong style="color: blue;"><span style="color: black;">超声诊断：脐疝。</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q5.itc.cn/q_70/images03/20240511/f4c3b91e44fb43928363e194b918f152.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">照片</span></span><span style="color: black;">1为腹部</span><span style="color: black;">高频探头<span style="color: black;">检测</span>，脐部疝囊内容物为肠壁，肠壁<span style="color: black;">没</span><span style="color: black;">显著</span>水肿、增厚，可见血流信号。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">视频</span><span style="color: black;">1</span><span style="color: black;">为患儿腹部高频探头<span style="color: black;">检测</span>，可见肠管样结构<span style="color: black;">经过</span>脐部疝出，在体表形成隆起性包块，包块随患儿<span style="color: black;">呼气</span>周期性变化。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">视频2为患儿脐疝临床表现：可见脐部<span style="color: black;">凸出</span>的软组织肿物，轻压可还纳，<span style="color: black;">没</span><span style="color: black;">显著</span>嵌顿，皮肤<span style="color: black;">没</span>颜色改变。 </span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">讨论：</span></strong><span style="color: black;">在人类胚胎<span style="color: black;">生长</span>过程中，形成脐环和脐带。脐带是胎儿从母体获取营养的通道，出生后剪断的脐带<span style="color: black;">通常</span>7天<span style="color: black;">上下</span>自然<span style="color: black;">脱落；脐带脱落、脐环闭锁时形成脐，呈<span style="color: black;">位置于</span>腹壁正中部的凹陷。胎儿<span style="color: black;">周期</span>脐带从腹壁穿过，致使脐部<span style="color: black;">作为</span>腹壁先天性薄弱处，是胚胎<span style="color: black;">生长</span>过程中腹壁最晚闭合的部位。脐由腹壁最外层的皮肤、筋膜与腹膜等腹壁多层组织直接连在<span style="color: black;">一块</span>，与其<span style="color: black;">周边</span>的腹壁相比，脐<span style="color: black;">无</span>皮下脂肪及肌肉组织，<span style="color: black;">作为</span><span style="color: black;">所有</span>腹壁最薄弱的部位。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">脐疝<span style="color: black;">指的是</span>腹腔内容物由脐部薄弱区<span style="color: black;">明显</span>形成的腹外疝，<span style="color: black;">根据</span>发病年龄可分为婴儿脐疝和成人脐疝。</span><span style="color: black;"><span style="color: black;">根据</span>解剖形态分为脐正中疝和脐旁疝，婴儿脐疝均为脐正中疝，成人脐疝则以脐旁疝为主，成人脐疝发病率<span style="color: black;">亦</span>远<span style="color: black;">小于</span>婴儿脐疝。 </span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">婴儿脐疝多为先天性，是新生儿和婴儿时期<span style="color: black;">平常</span>的<span style="color: black;">疾患</span>之一，较<span style="color: black;">平常</span>，多属易复性疝，嵌顿少见。在婴儿期，两侧腹肌未完全在中线处合拢，留有<span style="color: black;">缺失</span>。如婴儿哭闹<span style="color: black;">太多</span>、反复咳嗽、频繁腹泻等<span style="color: black;">原因</span>致使腹内压力<span style="color: black;">升高</span>，会<span style="color: black;">引起</span>腹腔内容物，<span style="color: black;">尤其</span>是小肠，连同腹膜<span style="color: black;">一块</span>由脐部薄弱处<span style="color: black;">逐步</span>向外顶出，致使腹壁皮肤隆起形成脐疝，直径多<span style="color: black;">少于</span>2厘米。最初<span style="color: black;">大都是</span>当伴有腹压增大动作时，脐部膨胀出包块，<span style="color: black;">通常</span>不<span style="color: black;">伴同</span>其它症状，常<span style="color: black;">没</span>意中<span style="color: black;">发掘</span>。随着病程<span style="color: black;">发展</span>，脐部膨胀出的包块可固定性存在，其<span style="color: black;">体积</span>可随<span style="color: black;">呼气</span>有<span style="color: black;">必定</span>改变。脐疝肿物<span style="color: black;">很强</span>时，<span style="color: black;">尤其</span>是<span style="color: black;">孩儿</span><span style="color: black;">连续</span>哭闹腹压<span style="color: black;">升高</span>时，可见表面的皮肤薄而透亮。用手指轻按压脐部肿物可使之缩小或回纳至腹腔<span style="color: black;">。脐部筋膜环的逐步收缩可使大<span style="color: black;">都数</span>的脐疝在一岁内自愈。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">成人脐疝除了极<span style="color: black;">少许</span>是婴儿脐疝的<span style="color: black;">连续</span>和复发外，<span style="color: black;">一般</span>是后天<span style="color: black;">得到</span>性的，多<span style="color: black;">出现</span>在中年以后，以女性多见，腹内压<span style="color: black;">升高</span>和腹壁过度牵拉是成人脐疝<span style="color: black;">出现</span>的<span style="color: black;">重点</span>病因。成人脐疝<span style="color: black;">不可</span>自愈，疝环<span style="color: black;">周边</span>的筋膜环组织相对坚韧，疝口<span style="color: black;">通常</span>小，易<span style="color: black;">出现</span>嵌顿或绞窄，须尽早手术治疗。成人脐疝多为脐环闭锁后，闭锁的脐环及<span style="color: black;">周边</span>的瘢痕组织受到<span style="color: black;">连续</span>的腹内压<span style="color: black;">升高</span>和腹壁过度牵拉，脐孔薄弱处<span style="color: black;">不可</span>抵挡而形成局部<span style="color: black;">缺失</span>并<span style="color: black;">逐步</span>扩大，<span style="color: black;">最后</span>腹腔内大网膜和肠管等通过<span style="color: black;">缺失</span>向体表<span style="color: black;">明显</span>，即形成成人脐疝。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">超声<span style="color: black;">检测</span>可<span style="color: black;">做为</span>诊断脐疝的首选<span style="color: black;">检测</span>，<span style="color: black;">能够</span>直观呈现脐部包块<span style="color: black;">体积</span>的变化，并<span style="color: black;">表示</span>疝口、内容物，并且<span style="color: black;">评定</span>疝囊内疝入肠管的状态。 </span><a style="color: black;"><span style="color: black;">返回<span style="color: black;">外链论坛：http://www.fok120.com/</span>，查看<span style="color: black;">更加多</span></span></a></p>
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