Miyaki A, Yamaguchi K, Kishibe S, Ida A, Miyauchi T, Naritaka Y
Department of Surgery, Nagareyama Central Hospital, 2-132-2 Higashihatsuishi, Nagareyama, Chiba, 270-0114, Japan.
Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.
Hernia. 2017 Oct;21(5):705-713. doi: 10.1007/s10029-017-1640-9. Epub 2017 Aug 10.
The aim of this study was to investigate the efficacy of prone-position computed tomography (CT) for detecting and classifying inguinal hernia relative to supine-position CT before laparoscopic inguinal hernia repair.
Seventy-nine patients who underwent laparoscopic transabdominal preperitoneal repair of inguinal hernia were enrolled in this prospective study. Patients diagnosed with inguinal hernia by physical examination underwent abdominal CT in the supine and prone positions for preoperative assessment. The anatomy of the right and left inguinal regions was confirmed during the surgery and compared with the preoperative CT findings.
The 79 cases included 87 operated lesions and 71 non-operated contralateral inguinal sites. Of the 84 clinical hernias, inguinal hernia was detected significantly more frequently on prone-position CT images (84, 100%) than on supine-position CT images (55, 65.5%). In addition, the inguinal hernia type was determined with significantly greater accuracy on prone-position CT images (96.4%) than on supine-position CT images (58.3%). Twenty-two occult hernias were detected by laparoscopy. The detection rate and accuracy for determining the type of occult hernia were significantly greater when using prone-position CT images [19 of 22 lesions (86.4%) and 77.3%, respectively] than when using supine-position CT images [8 of 22 lesions (36.4%) and 27.3%, respectively].
Prone-position CT is adequate for detecting and classifying inguinal hernia and for evaluating occult hernia.
本研究旨在探讨在腹腔镜腹股沟疝修补术前，俯卧位计算机断层扫描（CT）相对于仰卧位CT在检测和分类腹股沟疝方面的疗效。
本前瞻性研究纳入了79例行腹腔镜经腹腹膜前腹股沟疝修补术的患者。经体格检查诊断为腹股沟疝的患者在仰卧位和俯卧位接受腹部CT检查以进行术前评估。手术过程中确认左右腹股沟区的解剖结构，并与术前CT检查结果进行比较。
79例患者包括87个手术病变部位和71个未手术的对侧腹股沟部位。在84例临床疝中，俯卧位CT图像上检测到腹股沟疝的频率显著高于仰卧位CT图像（84例，100%对比55例，65.5%）。此外，俯卧位CT图像确定腹股沟疝类型的准确性显著高于仰卧位CT图像（96.4%对比58.3%）。腹腔镜检查发现22例隐匿性疝。使用俯卧位CT图像时，隐匿性疝的检出率和类型确定准确性显著高于仰卧位CT图像[分别为22个病变中的19个（86.4%）和77.3%对比22个病变中的8个（36.4%）和27.3%]。
俯卧位CT足以检测和分类腹股沟疝并评估隐匿性疝。
