穿孔性阑尾炎CT诊断及其治疗效果评价

Diagnostic value and therapeutic evaluation of CT on perforated appendicitis

目的研究穿孔性阑尾炎CT诊断及治疗评价。方法选取本院2016年7月-2017年3月92例诊断为穿孔性阑尾炎并行阑尾切除的患者,通过CT、B超、临床表现、病史、实验室检验及相关检查的比较明确CT诊断的价值,并将患者分为开腹阑尾切除组和腹腔镜阑尾切除组,通过对患者一般临床资料、并发症、并发症的种类、住院时间等指标对腹腔镜阑尾切除的疗效进行评价。结果通过患者术前、术中、术后病理诊断的对比,98例患者经术中、术后诊断为穿孔性阑尾炎92例(91.8%),非穿孔性阑尾炎6例(6.2%)。CT诊断为穿孔性阑尾炎91例(92.8%),非穿孔性阑尾炎7例(7.2%),灵敏度为98.9%,特异度为83.3%。CT诊断7例(7.2)非穿孔性阑尾炎,其中2例(2%)为术中证实为穿孔性阑尾炎,3例(3.1%)为阑尾周围脓肿,2例(2%)为急性坏疽性阑尾炎。CT对于诊断穿孔性阑尾炎灵敏度为98.9%,特异度为83.3%;行腹腔镜阑尾切除治疗,穿孔性阑尾炎及非穿孔性阑尾炎经腹腔镜手术在并发症方面均较开腹手术有明显的优势,尤其是穿孔性阑尾炎经腹腔镜阑尾切除术后未见相关并发症增加,切口感染,盲肠瘘,阑尾动脉出血,住院时间等方面均有统计学差异。结论CT诊断穿孔性腹膜炎具有较高的诊断价值,腹腔镜阑尾切除治疗取得良好的效果,值得临床进一步推广。

Objective To study the diagnosis and treatment of CT in treatment with perforated appendicitis.Methods From July2016 to March 2017,92 cases of perforating appendicitis with appendectomy were selected.The diagnostic value of CT was confirmed by CT,B-ultrasound,clinical manifestations,medical history,laboratory tests and related examinations.The patients were divided into open appendectomy group and laparoscopic appendectomy group.The efficacy of laparoscopic appendectomy was evaluated in terms of symptoms,types of complications and length of stay.Results By comparing the pathological diagnosis of 98 patients before,during,and after operation,98 patients underwent operation.92 cases（91.8%）were diagnosed as perforated appendicitis,6 cases（6.2%）as non-perforated appendicitis.91 cases（92.8%）were diagnosed as perforated appendicitis by CT,7 cases（7.2%）were diagnosed as non-perforated appendicitis.The sensitivity was 98.9%.The specificity was 83.3%.CT in 7 cases（7.2）of non-perforated appendicitis.Among them,2 cases（2%）were confirmed as perforated appendicitis,3 cases（3.1%）were periappendicitis,2 cases（2%）were acute gangrenous appendicitis,the sensitivity and specificity of CT for diagnosis of perforated appendicitis were 98.9 and 83.3%respectively.The complications of perforated appendicitis and non-perforated appendicitis were obviously superior to those of open appendicitis,especially the complications of perforated appendicitis were not increased after laparoscopic appendectomy.There were significant differences in incision infection（P〈0.05）,caecal fistula（P〈0.05）,appendiceal artery hemorrhage（P〈0.05）and hospital stay（P〈0.05）.Conclusion CT diagnosis of perforated peritonitis has a high diagnostic value,laparoscopic appendectomy has achieved good results,and it is worthy of further clinical promotion.