阑尾炎声像图特征与病理改变关系的初步探讨

Preliminary study of the relationship between ultrasonographic features and pathologic changes of appendicitis

目的探讨阑尾炎声像图特征与病理改变的关系。方法对75例临床拟诊为阑尾炎的患者进行超声检查,注意观察小肠积液、小肠壁增厚、大网膜移位、肠系膜淋巴结肿大与各型阑尾炎的关系,并与手术及病理结果对照分析。结果术前超声检出各型阑尾炎与手术病理诊断符合69例(69/75),误诊2例,漏诊4例。声像图特征为阑尾增粗,直径≥6mm,阑尾壁厚度≥2mm,黏膜毛糙、回声中断或消失,阑尾腔内积液。其中超声检出单纯性阑尾炎27例(27/30):超声显示阑尾轻度肿大,病理见阑尾病变局限于黏膜层及黏膜下层,黏膜部分脱落有浅表溃疡;化脓性阑尾炎22例(22/23):超声显示阑尾肿大明显,病理见阑尾炎症水肿较重,黏膜溃疡扩大,阑尾腔内积脓,阑尾周围炎性渗出物增多;坏疽性阑尾炎10例(10/12)及阑尾周围脓肿10例(10/10):超声显示阑尾形态消失,轮廓、壁层次不清,出现阑尾黏膜溃烂,腔内积脓积血,组织部分或全部坏死及阑尾穿孔等病理表现。结论各型阑尾炎声像图特征与病理改变密切相关。

Objective To investigate the relationship between the uhrasonographic characteristics and pathologic changes of appendicitis. Methods Uhrasonography was performed in 75 patients who were clinically diagnosed to probably have appendicitis. The small intestinal hydrops, thickening of the small intestinal wall, displacement of the great omentum, mesenteric lymphadenectasis and their relation with various types of appendicitis were observed and analyzed. The ultrasonic results were compared with the pathologic findings. Results Of the 75 patients, 69 were diagnosed to have appendicitis by preoperative ultrasound ; 2 were misdiagnosed; and 4 were missed. The coincidence of ultrasonic examination with the surgical/pathologic findings were as follows： simple appendicitis in 27 cases （27/30）, purulent appendicitis in 22 cases （ 22/23 ）, gangrenous appendicitis in 10 cases （ 10/12 ） and periappendicular abscess in 10 cases （ 10/10 ）. The uhrasonographic features of these cases were appendiceal widening with diameter≥6 mm, appendiceal wall ≥ 2 mm in thickness, crude mucosa, echo breaks or disappearance, fluid accumulated within the appendiceal cavity. Conclusions The uhrasonographic characteristics are closely correlated with the pathologic changes in appendicitis.