MSCT诊断异位急性阑尾炎的临床价值分析

Value of multi slice CT 3D reconstruction in diagnosis of ectopic appendicitis

目的探讨多层螺旋CT(MSCT)对异位急性阑尾炎的的诊断价值。方法搜集26例临床首诊非急性阑尾炎,而经MSCT诊断为异位急性阑尾炎的病例,分析其CT表现及特征,并将诊断结果与手术及病理结果进行对照分析。结果 26例异位阑尾炎患者中,高位阑尾炎5例,盆腔阑尾炎20例,反向转位阑尾炎1例,其中1例为右侧腹股沟疝合并急性阑尾炎。CT表现直接征象为异位的阑尾水肿,增粗、管壁增厚,阑尾腔内粪石,间接征象为阑尾周围炎,肠系膜增厚,肠系膜根部淋巴结肿大。所有阑尾炎病例中,CT诊断为单纯性阑尾炎7例,化脓性阑尾炎19例,并阑尾腔内肠石6例,均行手术切除,与病理结果一致。结论异位急性阑尾炎有典型的CT表现,MSCT的平扫及图像后处理技术的联合应用,能直观地显示异位的阑尾的位置、形态及病理改变,在对异位急性阑尾炎的快速、准确的诊断中,有重要的临床应用价值。

Objective To investigate the value of multi slice CT （MSCT） in the diagnosis of ectopic acute appendicitis. Methods 26 patients with clinical first diagnosis of non-acute appendicitis, but, MSCT diagnosis of ectopic acute appendicitis were enrolled in the study. The CT manifestations and characteristics were analyzed, and the diagnostic results were contrastly an- alyzed with surgery and pathology findings. Results Of the 26 cases with ectopic appendicitis patients, there were high appendi- citis in 5 cases, pelvic appendicitis in 20 cases, reverse transposition appendicitis in 1 case, in which the right inguinal hernia was complicated with acute appendicitis in 1 case. The CT direct signs of ectopic appendix included edema, enlargement, thick- ening with the wall of appendix, appendiceal fecalith, the indirect signs included inflammation around the appendix, thickening of mesentery, demonstrating enlarged mesenteric lymphnodes. In all cases of appendicitis, there was simple appendicitis in 7 cases, suppurative appendicitis in 19 cases, and appendix cavity enterolith in 6 cases, they were all surgically resection and consistent with the pathological results. Conclusion The characteristic CT findings could be assessed in ectopic acute appendicitis, com- bined with MSCT scan and postprocessing technique, they can visually display the eetopic appendix position, change the morphol- ogy and pathology in ectopic acute appendicitis in rapid and accurate diagnosis, which shows important clinical value.