急性阑尾炎的超声征象与病理分型的关系研究

Study on the relationship between ultrasonographic signs and pathological classification of acute appendicitis

目的研究急性阑尾炎的超声征象与病理分型的关系,为临床分型提供客观依据。方法收集外科2016年9月~2017年9月急腹症经术后病理证实为急性阑尾炎的患者156例,根据病理类型分为单纯性阑尾炎组(n=42)、化脓性阑尾炎(n=83)和坏疽性阑尾炎(n=31)三组,比较三组超声征象,包括阑尾大小、周围积液情况、黏膜下层厚度、腔内粪石及肠系膜区淋巴结等,应用受试者工作特征(ROC)曲线评估各项指标诊断急性阑尾炎的临床价值。结果三组患者的阑尾短径和黏膜下层厚度差异均具有统计学意义(P <0.05),而三组患者的阑尾长径无统计学差异,两两比较,坏疽性阑尾炎组的阑尾短径长于单纯性阑尾炎组和化脓性阑尾炎组,坏疽性阑尾炎组与化脓性阑尾炎组的黏膜下层厚度高于单纯性阑尾炎组,差异具有统计学意义(P <0.05),三组间两两比较,单纯性阑尾炎组、化脓性阑尾炎组靶环征检出率明显高于坏疽性阑尾炎组,差异有统计学意义(χ^2=1.223,P=0.001)。三组间两两比较,化脓性阑尾炎组阑尾周围积液检出率明显高于单纯性阑尾炎组和坏疽性阑尾炎组,坏疽性阑尾炎组检出率明显高于单纯性阑尾炎组,差异均有统计学意义(χ^2=5.223,P=0.001)。三组间腔内粪石、肠系膜区淋巴结检出率比较差异均无统计学意义(P=0.008)。结论急性阑尾炎患者的超声征象明显,其中部分征象如靶环征可为病理分型提供依据,综合分析有助于病理分型的鉴别诊断,为临床治疗方案的制定提供依据。

Objective To study the relationship between ultrasonographic signs and pathological classification of acute appendicitis, and to provide objective basis for clinical classification. Methods 156 patients with acute appendicitis confirmed by surgical pathology from September 2016 to September 2017 were divided into simple appendicitis group(n = 42), suppurative appendicitis group(n = 83) and gangrenous appendicitis group(n = 31) according to pathological type. The ultrasonographic signs of three groups were compared, including appendix size, peripheral fluid accumulation, submucosal thickness, intraluminal fecal stones and mesentery. The clinical value of each index in the diagnosis of acute appendicitis was evaluated by ROC curve. Results There were significant differences in Appendix short diameter and submucosal thickness between the three groups(P < 0.05), but there was no significant difference in Appendix long diameter between the three groups. Compared with the two groups, the appendix short diameter of gangrenous appendicitis group was longer than that of simple appendicitis group and purulent appendicitis group, and the submucosal thickness of gangrenous appendicitis group and purulent appendicitis group was higher than that of simple appendicitis group. The difference was statistically significant(P < 0.05). The detection rate of target ring sign in simple appendicitis group and purulent appendicitis group was significantly higher than that in gangrenous appendicitis group(χ~2= 1.223, P = 0.001). The detection rate of periappendiceal effusion in purulent appendicitis group was significantly higher than that in simple appendicitis group and gangrenous appendicitis group. The detection rate in gangrenous appendicitis group was significantly higher than that in simple appendicitis group, the difference was statistically significant(χ~2= 5.223, P = 0.001). There was no significant difference in the detection rates of intraluminal fecal stones and mesenteric lymph nodes among the three groups(P = 0.008). Conclusion Ultrasound signs are obvious in patients with acute appendicitis. Some of them, such as target ring sign, can provide basis for pathological classification. Comprehensive analysis is helpful for differential diagnosis of pathological classification and for the formulation of clinical treatment plan.