高频和低频超声检查在阑尾炎间接超声征象中的诊断价值

Diagnostic value of high and low frequency ultrasonography examination on indirect ultrasound signs of appendicitis

目的比较高、低频超声检查对阑尾炎患者间接征象的显示差异,评价其在阑尾炎间接征象中的诊断价值。方法选择2011年1月至2014年5月中山市人民医院收治的阑尾炎患者153例,患者临床症状体征不典型,分别采用低频超声及高频超声检查并比较间接征象,并结合手术病理及随访结果进行分析。结果 153例均经术后病理及复查结果确诊,其中急性单纯性阑尾炎93例,阑尾周围脓肿19例,急性蜂窝组织性阑尾炎32例,急性坏疽性阑尾炎9例,超声诊断准确性为79.1%(121/153)。采用低频及高频超声检查对回盲部水肿、阑尾肿大增粗及阑尾壁增厚等间接征象的检出差异具有统计学意义(P<0.05)。在高频超声显示的间接征象与术中所见征象的一致性检验中,所有的Kappa值均>0.8。结论对临床症状体征不典型的阑尾炎患者,高频超声检查可提高间接征象的显示率,低频联合高频超声检查可以提高阑尾炎的诊断准确性。

Objective To compare the difference of indirect ultrasound signs by high and low frequency uhrasonography and to evaluate the value on the diagnosis of appendicitis. Methods The clinical data of one hundred and fifty-three patients with appendicitis admitted to Zhongshan City People＇s Hospital from January 2011 to May 2014 were retrospectively analyzed. The clinical symptoms and signs of the patients were atypical and they were examined by low and high frequency uhrasonography. The indirect ultrasound signs were analyzed and compared with pathology results and clinical follow-up. Results The diagnostic accuracy of uhrasonography in 153 cases was 79.1% （121/153）. There were 93 cases of simple appendicitis, 19 cases of appendiceal abscess, 32 of acute cellular appendicitis, 9 of acute gangrenous appendicitis, and the diagnosis was confirmed by pathology and follow-up. The low frequency and high frequency uhrasonography showed significant differences in the detection of indirect signs such as edema of ileocecal, enlargement of appendix and thickening of appendix wall （P〈0.05）. All of the Kappa values were greater than 0.8 in the coincidence test between the indirect signs of high-frequency ultrasound and the signs seen during surgery. Conclusion For appendicitis patients with atypical clinical symptoms and signs, high frequency ultrasonography can improve the detection rate, and improve the diagnostic accuracy of appendicitis when combined with low frequency ultrasound.