三种病理类型急性阑尾炎患者的临床体征及多层螺旋CT征象特点差异性分析

Differences in Clinical Signs and Multi-Slice Spiral CT Findings of Patients with Three Pathological Types of Acute Appendicitis

目的分析坏疽性阑尾炎、化脓性阑尾炎、单纯性阑尾炎三种病理类型急性阑尾炎患者的临床体征及多层螺旋CT(MSCT)征象特点差异性。方法回顾性分析我院2013年9月至2015年9月期间90例急性阑尾炎患者的临床资料,其中急性单纯性阑尾炎41例,急性化脓性阑尾炎37例,急性坏疽性阑尾炎12例,所有患者在术前均进行MSCT扫描,分析所有患者MSCT图像征象并与最终病理结果对照,比较不同病理类型急性阑尾炎患者MSCT征象特点差异。结果单纯性阑尾炎组患者CRP、白细胞计数、中性粒细胞百分比较化脓性阑尾炎组、坏疽性阑尾炎组均显著较低(P<0.05);化脓性阑尾炎组CRP、白细胞计数、中性粒细胞百分比较坏疽性阑尾炎组显著较低(P<0.05)。单纯性阑尾炎MSCT显示阑尾轻微肿胀,阑尾处边缘不清,管腔内存在液体样的阴影;化脓性阑尾炎阑尾明显肿胀,边界模糊,可见絮状以及条索状的阴影,盲肠壁增厚;坏疽性阑尾炎阑尾明显增粗,阑尾周围积气明显,阑尾与盲肠壁增厚,边界模糊不清。结论急性阑尾炎不同病理类型临床表现不典型,而MSCT征象具有典型差异性,MSCT对诊断不同病理类型急性阑尾炎具有较高的指导价值,值得临床应用推广。

Objective To analyze the differences in clinical signs and multi-slice spiral CT （MSCT） findings of patients with gangrenous appendicitis, suppurative appendicitis and simple appendicitis. Methods The clinical data of 90 patients with acute appendicitis admitted in our hospital during September 2013 to September 2015 were analyzed retrospectively. Among them, there were 41 cases with acute simple appendicitis, 37 cases with acute suppurative appendicitis and 12 cases with acute gangrenous appendicitis. All patients underwent MSCT scan before operation. The MSCT findings of all patients were analyzed and compared with the final pathological findings. The MSCT findings were compared between patients with different pathological types of acute appendicitis. Results CRP, white blood cell count and percentage of neutrophilsila simple appendicitis group were significantly lower than those ill suppurative appendicitis group and gangrenous appendicitis group （P〈0.05）. CRP, white blood cell count and percentage of neutrophilsin suppurative appendicitis group were significantly lower than those in gangrenous appendicitis （P〈0.05）. MSCT of simple appendicitis showed slight swelling of appendix, unclear edges of appendix and liquid-like shadow in the lumen： Suppurative appendicitis showed obvious swelling, fuzzy boundaries, visible flocculent and strip like shadows, cecal wall thickening; Gangrenous appendicitis showed obvious thickening, obvious periappendiceal pneumatosis, appendix and cecum wall thickening and blurred bonndaries. Conclusion The clinical manifestations of different pathological types of acute appendicitis were atypical while MSCT findiugs are typical differences. MSCT is of high guidance value in the diagnosis of different pathological types of acute appendicitis and is worthy of clinical application.