解剖参照法在正常阑尾超声检查中的应用

Application of the anatomic reference method in diagnosis of the normal vermiform appendix by ultrasonic inspection

目的分析回盲部的超声声像图特点和正常阑尾解剖位置,以提高正常阑尾的检出率。方法对104例健康体检者的回盲部及正常阑尾进行超声检查,并对其中52例检出阑尾者进行动态超声观测。结果回盲部和阑尾的超声显示率分别为98.1%(102/104)、85.6%(89/104),回盲部显示率明显高于阑尾(P<0.01);正常阑尾与回盲瓣的距离为(14.2±6.2)mm,正常阑尾传统前后外径为(4.3±0.9)mm,校正后的阑尾直径为(6.0±1.2)mm,均明显小于回肠末段对应的外径(P<0.01);52例动态观测者中23.1%(13/52)的超声回盲瓣出现分型的不同,48.1%(25/52)的正常阑尾解剖位置发生了改变。结论超声回盲瓣可作为回盲部的判定标志。采用"阑尾开口位置→弯折处钟点→盲端钟点:毗邻关系"的钟表描述法来描述阑尾的解剖位置更符合实际。以回盲瓣为根本的解剖参照物、在其附近3cm范围内寻找阑尾开口进而确定阑尾的解剖学参照法,具有可行并可推广的临床应用价值。

Objective To analyze the feature of ileocecus and the anatomical location of the normal vermiform appendix by ultrasound and to improve the detection rate of appendix.Methods By application of ordinary B-mode ultrasonic instruments,104 control cases of healthy subject with check-up were taken with ultrasound of ileocecus and appendix,52 cases of volunteers who had detected the appendix of them were taken for dynamic ultrasound observation.Results The detection rate of ileocecus and appendix by ultrasound was 98.1%（102/104） and 85.6%（89/104）,respectively.The rate of the ileocecus was higher than that of the appendix（P0.01）.The distance between appendix and ileocecal valve was 14.2±6.2 mm.The traditional anteroposterior outer appendicular diameter was 4.3±0.9 mm and adjusted diameter was 6.0±1.2 mm.Their diameter was smaller than that of terminal ileum（P0.01）.In 52 cases of dynamic observers,23.1%（13/52） of them had changed the divided types of the ultrasonic ileocecal valve,and 48.1%（25/52） of them had changed their initiative checked anatomic position.Conclusion The ultrasonic ileocecal valve is a sonographic feature of the ileocecus.It is more reliable for the Clocks Description Method with ＂appendicular root position→bend clock→blind ending clock：position adjacent to other organs in identification of the appendicular anatomical location.Considering the ileocecal valve as the basic anatomic frame in reference,which in its 3 cm around to seek appendicular openings,the anatomic reference method is feasible and can improve the value of clinical applications.