老年人正常阑尾及急性阑尾炎阑尾的多层螺旋CT表现

Multidetector CT Feathers of Normal Appendices and Appendices of Acute Appendicitis in Old Patients

目的 分析老年人正常阑尾与老年人急性阑尾炎阑尾的多层螺旋CT（MDCT）表现,探讨MDCT在评价老年人急性阑尾炎中的临床价值。方法 回顾性分析2016年6-10月期间于四川大学华西医院行MDCT扫描后24 h内经手术证实为急性阑尾炎的66例老年患者,以及2016年9-10月期间于四川大学华西医院因非腹痛原因而行MDCT检查的40例无阑尾病变患者的MDCT资料。观察内容包括：阑尾的位置、直径、壁厚度、腔内内容物及阑尾周围结构改变。结果 1阑尾显示率。急性阑尾炎组患者的MDCT阑尾显示率为95.5%（63/66）,正常阑尾组为95.0%（38/40）。2组MDCT阑尾显示率比较差异无统计学意义（P〉0.05）。2阑尾位置。急性阑尾炎组：盆位22例,回肠前位2例,回肠后位10例,盲肠下位25例,盲肠后位4例;正常阑尾组：盆位15例,回肠前位3例,回肠后位7例,盲肠下位5例,盲肠后位8例。2组的阑尾位置分布比较差异有统计学意义（P〈0.05）,急性阑尾炎组的阑尾主要分布在盆位和盲肠下位,正常阑尾组的阑尾主要分布于盆位。3阑尾直径及阑尾壁厚。急性阑尾炎组患者的阑尾直径为（11.4±4.2）mm（6.2-21.9）mm,阑尾壁厚为（4.3±2.2）mm（1.1-8.6）mm;正常阑尾组患者的阑尾直径为（6.1±1.4）mm（3.7-8.6）mm,阑尾壁厚为（1.7±0.8）mm（0.5-3.2）mm。急性阑尾炎组的阑尾直径及壁厚均大于正常阑尾组（P〈0.05）。4阑尾腔内内容物。急性阑尾炎组：阑尾腔内表现为积液伴少许积气14例,全部积液36例,高密度粪石伴腔内积液13例。正常阑尾组：阑尾腔内全部气体15例,大部分气体伴稍高密度粪影13例,无内容物10例。急性阑尾炎组的阑尾腔内容物以积液为主,正常阑尾组以气体为主。5阑尾周围情况。急性阑尾炎组：脂肪条带征57例,邻近壁腹膜增厚56例,阑尾周围局限性积液18例,脓肿2例,腹腔游离气体8例,阑尾系膜淋巴结肿大35例。正常阑尾组无一例出现脂肪条带征、邻近壁腹膜增厚、阑尾周围局限性积液、腹腔游离气体及阑尾系膜淋巴结肿大。结论 MDCT能清晰地显示老年人正常阑尾及急性阑尾炎阑尾的本身及周围特征,对老年人急性阑尾炎具有较高的诊断准确性,临床上可为术前诊断及处理提供有力依据。

Objective To analyze the multidetector computed tomography （MDCT） findings of normal appendices and appendices of acute appendicitis in old patients, and to explore the clinical value of MDCT in assessing acute appendicitis in old patients. Methods Sixty-six cases of acute appendicitis confirmed by surgery in 24 hours after MDCT scan from ]un. to Oct. 2016 （acute appendicitis group）, and 40 cases underwent MDCT scan for non-abdominal pain causes without appendiceal lesions from Sep. to Oct. 2016 （normal appendices group）, were included, and the MDCT images of both 2 groups were retrospectively analyzed. Observation items included： location, diameter, mural thickness, intra-luminal contents, and changes of surrounding structures. Results （1） Rate of appendices visualization. In total of 95.5% （63/66） appendices were visualized on MDCT in acute appendicitis group, while 95.0% （38/40） appendices were visualized on MDCT in normal appendices group （P〉0.05）. （2） Locations of appendices. Acute appendicitis group： appen- dices were found to be located at pelvic cavity in 22 cases, in front of ileum in 2 cases, behind ileum in 10 cases, below cecum in 25 cases, and behind cecum in 4 cases. Normal appendices group： appendices were found to be located at pelvic cavity in 15 cases, in front of ileum in 3 cases, behind ileum in 7 cases, below cecum in 5 cases, and behind cecum in 8 cases. There was significant difference between 2 groups in terms of location of appendices （P〈0.05）. The appendices in acute appendicitis group located mainly at pelvic cavity and below cecum, while the appendices in normal appendices group located mainly at pelvic cavity. （3） The diameter and thickness of appendices. The appendiceal diameter and thickness in acute appendicitis group were （11.4±4.2） mm （6.2-21.9） mm and （4.3±2.2） mm（1.1-8.6） mm, respectively, while those in normal appendices group were （6.1±1.4） mm （3.7-8.6） mm and （1.7±0.8） mm （0.5-3.2） ram, respectively. The diameter and thickness of appendices in acute appendicitis group were significantly greater than those in normal appendices group, respectively （P〈0.05）. （4） Contents of appendices. Acute appendices group： there was effusion with air in 14 cases in appendiceal cavity, full of effusion in 36 cases, and appendicolith combined with effusion in 13 cases. Normal appendices group： there was full of air in 15 cases in appendiceal cavity, air with a little faeces of higher density in 13 cases, and nothing in 10 cases. Effusion was more common in appendiceal cavity in acute appendicitis group, while air was more common in normal appendices group. （5） Around appendices. Fat stranding was seen in 57 cases, adjacent parietal peritoneum thickening was seen in 56 cases, focal effusion was seen in 18 cases, abscess was seen in 2 cases, free air in peritoneal cavity was seen in 8 cases, and lymphadenopathy was seen in 35 cases. None of these imaging features were seen in normal appendices group. Conclusions MDCT can demonstrate features of normal appendices and acute appendicitis in old patients. MDCT yield high diagnostic accuracy in acute appendicitis in old patients, and can provide useful information before surgery.