关于阑尾炎影像学诊断的综合分析

Comprehensive analysis on imaging diagnosis of the appendicitis

目的:探讨与总结腹部平片、低张气钡逆行灌肠双重造影、多层螺旋CT在阑尾炎诊断中的影像学特征与应用价值。方法与资料:收集2008年1月—2016年3月临床收治的阑尾炎患者168例,48例采用腹部平片检查,39例采用低张气钡逆行灌肠双重造影,81例采用多层螺旋CT检查,将影像学检查与临床及手术病理结果对照,分析各种检查的影像学特征表现,统计诊断准确率。结果:腹部平片48例中正确诊断出阑尾炎11例,敏感性为13%;低张气钡逆行灌肠双重造影39例中诊断出阑尾炎22例,阑尾未显影11例,未发现病变6例,诊断符合率达56%;多层螺旋CT检查81例中诊断出阑尾炎60例,阑尾显示正常6例,阑尾未显示8例,误诊为其他病变7例,诊断准确率达74%。腹部平片与低张气钡逆行灌肠双重造影,以及低张气钡逆行灌肠双重造影与多层螺旋CT之间的准确率差异有统计学意义(P<0.05)。结论:腹部平片对阑尾炎的诊断仅提供一些间接征象,仅能对部分病例作出提示性诊断,应用价值有限;低张气钡灌肠双重造影对阑尾炎诊断的准确性较高,但检查过程复杂,显影率不高,对阑尾穿孔及化脓病例可能延误甚至加重病情,运用局限;多层螺旋CT对阑尾及周围病变显示清晰,诊断符合率极高,为临床对阑尾炎的诊断及治疗提供了重要依据,值得重视及推广。

Objective To explore the imaging features and summarize the application value of abdominal plain film, low tension barium retrograde enema double contrast, and multi-slice spiral CT in the diagnosis of appendicitis. Methods 168 cases of appendicitis were collected from January 2010 to March 2016. Among the 168 cases, 48 cases underwent abdominal plain film examination, 39 cases underwent double contrast barium enema and 81 cases received multi-slice spiral CT. Through the comparison of imaging examination and clinical surgical pathology results, andthe analysis of various imaging features of the examination, diagnostic accuracy was statistically obtained.Results In the 48 cases of abdominal plain film, 11 cases were diagnosed correctly with appendicitis, the sensitivity was 13%. In the 39 cases of low contrast barium retrograde enema double diagnosis, there were 22 cases of appendicitis, 11 cases of appendicitis, and 6 cases of no lesions were diagnosed, the coincidence rate of diagnosis was 56%. Among the 81 cases diagnosed by appendicitis, 60 cases were diagnosed with appendicitis, 6 cases showed normal appendix, 8 cases showed no appendix and 7 cases were misdiagnosed as other diseases, the diagnostic accuracy was 74%.There were significant differences in accuracy between abdomen plain film and low tension barium retrograde enema double contrast, double barium retrograde enema double-contrast and multi-slice spiral CT （P 〈0.05）.Conclusion The diagnosis of appendicitis in abdominal plain film only provides some indirect signs and can only make prompt diagnosis in some cases, the application value is limited. The double contrast barium enema has a higher accuracy in the diagnosis of appendicitis, but the examination process is complicated and the development rate is not high,the appendix perforation and suppuration cases may delay or even aggravate the condition. Multi-slice spiral CT on the appendix and peripheral lesions showed a clear, very high diagnostic rate for the clinical diagnosis and treatment of appendicitis provides an important basis for the clinical manifestations of appendicitis, which is worthy of attention and promotion.