高频超声联合临床Alvarado评分在降低阑尾炎误漏诊率中的价值

The value of high frequency ultrasound combined with clinical Alvarado score in reducing misdiagnosis of appendicitis

目的:探讨高频超声联合临床Alvarado评分在阑尾炎超声诊断中的应用价值及误漏诊原因分析,以便进一步提高高频超声诊断阑尾炎的准确性。方法:回顾性分析99例临床疑似阑尾炎患者的声像图特征,参照临床Alvarado评分并对照术后病理结果,评估其诊断的敏感性、特异性、阳性预测值、阴性预测值及Kappa值。结果:手术病理确诊阑尾炎99例,高频超声诊断87例(87.88%),漏诊10例(10.10%),误诊2例(2.02%)。术前高频超声联合临床Alvarado评分与术后病理对照诊断阑尾炎的敏感度96.55%,特异度83.33%,差异有统计学意义(P<0.05);Kappa值为0.771,表明术前高频超声联合临床Alvarado评分和术后病理诊断具有较高的一致性。结论:高频超声联合临床Alvarado评分诊断阑尾炎具有较高的灵敏度与特异度,有助于及时正确把握患者症状与体征,提高早期诊断效能,对鉴别诊断各类型阑尾炎和降低阑尾炎漏误诊率有重要价值,可进一步提高高频超声诊断各型阑尾炎的准确度。

Objective：To investigate the value of high-frequency ultrasound combined with clinical Alvarado scoring system in the diagnosis of appendicitis and the analysis of misdiagnosis.To further improve the accuracy of high-frequency ultrasound diagnosis of appendicitis.Method：According to the clinical Alvarado score and the postoperative pathology,the ultrasonographic features of 99 cases of suspected appendicitis were retrospectively analyzed to evaluate the sensitivity,specificity,positive predictive value,negative predictive value and Kappa value of appendicitis.Result：The pathology diagnoses 99 cases of appendicitis.The high frequency ultrasound diagnoses 87 cases of appendicitis.Ten cases of missed diagnosis（missed diagnosis rate of 10.10%）.Two cases of Misdiagnosis（misdiagnosis rate of 2.02%）.Preoperative high-frequency ultrasound combined with clinical Alvarado score and stoperative pathological diagnosis of appendicitiss sensitivity and specificity are etrospectively 95.11% and90.52%.Its statistical results P value is less than 0.05,the difference is statistically significant.Its Kappa value was 0.734,indicating that preoperative high-frequency ultrasound combined with clinical Alvarado score and postoperative pathological diagnosis has a high degree of consistency.Conclusion：High-frequency ultrasound combined with clinical Alvarado scoring system for the diagnosis of appendicitis has a high sensitivity and specificity,which helps to correctly grasp the symptoms and signs of patients,improve the early diagnosis,have an important value of diagnosing differently various types of appendicitis and reducing the rate of misdiagnosis of appendicitis leakage.