临床评分与超声检查评估儿童急性阑尾炎的价值

Comparison between clinical score and ultrasonography in pediatric appendicitis

目的探讨阑尾炎临床评分与超声检查的实用性及儿童阑尾切除术前超声检查的必要性。方法将68例因"急性阑尾炎"行阑尾切除术的患儿分为超声检查组和直接手术组,回顾性分析其临床资料和超声结果,并与手术病理结果对照。计算临床评分与超声检查诊断阑尾炎的准确性、敏感性和特异性。计算超声判断阑尾穿孔与粪石的准确性、敏感性和特异性。结果临床评分的总体准确率、敏感性及特异性分别为80.9%(55/68),83.1%(54/65),33.3%(1/3),超声检查的准确率、敏感性及特异性均为100%(56/56),两者差异有统计学意义(P=0.001):超声检查组与直接手术组的阑尾阴性切除率分别为1.8%(1/56)和16.7%(2/12);超声判断了阑尾穿孔,准确性、敏感性和特异性分别为81.8%(45/55)、85.7%(24/28)、88.8%(24/27)。超声判断阑尾粪石的准确性,敏感性、特异性分别为74.5%(41/55)、69.7%(23/33)、81.8%(18/22)。结论超声检查能够发现易被临床评分漏诊的不典型阑尾炎,有效降低阑尾阴性切除率,同时在判断阑尾穿孔与阑尾粪石上有一定价值。

Objective To compare the value of olinical appendicitis score and uhrasonography in diagnosing pediatric appendicitis. Methods The clinical appendicitis score and ultrasound findings of 68 children with appendectomy for suspected acute appendicitis were reviewed. In comparison with pathologic findings, the accuracy, sensitivity and specificity of clinical Score system and ultrasound in identifying appendicitis, appendiceal perforation and appendicolith were determined. Results The accuracy, sensitivity and specificity of clinical score system was 80.9% （55/68）, 83.1% （54/65） and 33.3% （1/3）, respectively. The accuracy of ultrasound was significantly higher atl00% （56/56, P = 0.001 ）. The negative appendectomy rates of patients with and without uhrasonography were 1.8% （1/56） and 16.7% （2/12）, respectively. The accuracy, sensitivity and specificity of ultrasound in identifying perforation were 81.8% （45/55）, 85.7% （24/28） and 88.8% （24/27）, respectively. The accuracy, sensitivity and specificity of ultrasound in identifying appendicolith were 74.5% （41/55）, 69.7% （23/33） and 81.8% （18/22）, respectively. Conclusion Uhrasonography demonstrated appendicitis in children with atypical clinical presentation. Ultrasonography was effective in decreasing the negative appendectomy rates and in identifying appendiceal perforation and appendicolith.