穿孔性阑尾炎的临床表现及CT表现

Clinical and CT features of acute perforated appendicitis

目的比较穿孔性和非穿孔性阑尾炎的CT及临床表现,探讨CT对穿孔性阑尾炎的诊断价值。方法术后回顾性分析109例阑尾炎患者,将其分为穿孔性阑尾炎和非穿孔性阑尾炎2组,分析及比较二组临床症状、体征、实验室检查及CT征象。结果症状持续超过3 d、右下腹痛性包块,CT上阑尾管壁缺损、阑尾周围积气、阑尾腔外结石、腹腔脓肿、蜂窝组织炎等对于穿孔性阑尾炎的诊断具有较大的特异性,而反跳痛、腹肌紧张及CT上阑尾直径、阑尾周围肠壁增厚在穿孔性阑尾炎组中出现的概率也高于非穿孔性阑尾炎组(P<0.05)。结论结合CT征象及临床表现可提高穿孔性阑尾炎的诊断,对于手术方案的选择具有较大的意义。

Objective To determine the symptoms, signs and CT features that differentiate perforated from non-perforated appendicitis. Methods The clinical records including symptoms, signs and laboratory results as well as CT findings of appendicitis in 109 patients were compared between those with and without appendiceal rupture. Results Duration of symptoms of more than 3 days, right lower abdomen painful mass, CT features of appendiceal wall defect, extraluminal air, extraluminal appendicolith, abscess or phlegmon are features that predict appendieeal rupture with high specificity. Rebound tenderness and guarding, CT findings including appendieeal diameter and bowel wall thickening were more common in perforated appendicitis. Conclusion CT and clinical findings can accurately determine appendiceal rupture in acute appendicitis.