64排CT口服甘露醇造影对急性阑尾炎的诊断价值

The Diagnostic Value of 64 Row CT Scanning after Oral Mannitol on Acute Appendicitis

目的评价64排CT口服甘露醇造影对急性阑尾炎的诊断价值。方法选择59例具有或疑有急性阑尾炎症状的患者,扫描前45min让患者分3次口服等渗甘露醇(2.5%)1500ml,每次摄入500ml,间隔15min左右;行64排螺旋CT平扫加增强扫描。回顾分析CT诊断结果与手术、病理结果,并进行对照分析。结果 59例患者中,44例手术病理证实为阑尾炎,4例经临床治疗后证实为阑尾炎,余11例有阑尾外病变,其中4例经病理证实为阑尾炎,4例输尿管石,3例经临床随访证实为阑尾炎。35例阑尾炎病例表现为阑尾增粗肿大,阑尾壁厚度7mm-10mm;增粗的阑尾边缘模糊,余12例合并阑尾脓肿而阑尾显示不清。9例表现为阑尾粪石。47例表现为阑尾周围炎症,表现为阑尾周围系膜脂肪组织中出现条索状、斑片状密度增高影(脂肪条带症);4例结肠后筋膜增厚、3例阑尾周围积液、1例合并蜂窝积炎以及12例脓肿形成。4例表现为邻近盲升结肠管壁局限性增厚。结论 64排CT口服甘露醇后能方便、准确地诊断急性阑尾炎,并能发现阑尾外病变。

Objective To evaluate the diagnostic value of 64 row CT scanning after oral mannitol in acute appendicitis patients. Methods 59 patients with or were suspected of acute appendicitis ingested 1500ml of 2.5% osmotic mannitol in 3 times, 500ml each time and every 15minutes, in 45 minutes before they underwent 64-row spiral CT plain plus enhanced scanning. The results of CT, operation, and pathological results were analyzed retrospectively. Results Of the 59 patients, 44 were confirmed of appendicitis surgically and pathologically, 4 were confirmed of appendicitis after clinical treatment, 11 with exter- nal diseases, in which 4 were confirmed of acute appendicitis pathologically, 4 were ureteral calculi, and 3 were confirmed by clinical follow-up. The appendix enlarged in 35 cases, with large caliber at diameter of 7 - 10 mm, with fuzzy edge. The appendix showed poorly in 12 cases with appendiceal abscess. The appendiceal stercorolith showed in 9 cases. Peri- appendiceal inflammation showed in 47 cases, with strip-shaped and funicular shadow and increased density in the mesangial tat tissue around the appendix （symptom of fat-strap）. The fascia posterior to colon thickened in 4 cases. Effusion around appendix showed in 3cases. Phlegmon showed in 1 case, while abscess showed in 12 cases. The part close to cecal apical of the appendix thickened locally in 4 cases. Of the 59 cases involved, external diseases of appendix were found in 11 cases. Conclusions 64 row CT scanning after oral mannitol detected acute appendicitis definitely and conveniently, and helps finding external diseases of appendix.