急性阑尾炎的MSCT表现与临床特点及病理类型对照分析

Analysis of MSCT manifestations,clinical features and pathological types in patients with acute appendicitis

目的:探讨单纯性、化脓性、坏疽性三种不同病理类型急性阑尾炎的临床特点及MSCT表现特征,提高对该病的认识。方法:回顾性分析我院2018年1-12月40例急性阑尾炎的临床特点及MSCT表现特征,其中单纯性阑尾炎8例(20%),化脓性阑尾炎25例(62.5%),坏疽性阑尾炎7例(17.5%),所有患者术前均进行MSCT扫描,分析不同病理类型阑尾炎的MSCT表现,并与临床特点如C反应蛋白(CRP)、降钙素原(PCT)、白细胞(WBC)计数等相结合,从而综合分析各种病理类型阑尾炎的诊断要点。结果:坏疽性阑尾炎组CRP、PCT、WBC计数较化脓性阑尾炎、单纯性阑尾炎组高(P<0.05),化脓性阑尾炎组CRP、PCT、WBC计数较单纯性阑尾炎组高(P<0.05);在MSCT方面,坏疽性阑尾炎主要表现为阑尾明显增粗,局部肠壁增厚,周围可见积气影,其中高密度粪石影离开阑尾腔游离于腹腔内有3例;化脓性阑尾炎阑尾增粗,边界模糊,局部见斑片状、条索状密度增高影;单纯性阑尾炎表现为轻度肿胀,阑尾周围间隙稍模糊,管腔内见少量液体密度影。结论:MSCT扫描结合CRP、PCT、WBC计数对不同病理类型急性阑尾炎诊断具有重要的指导意义,从而为临床治疗提供有力的证据,值得推广。

Objective:To explore the clinical and MSCT features of acute appendicitis of three different pathological types:simple,suppurative and gangrenous.Methods:Retrospective analysis of the 40 cases with acute appendicitis was made from January 2018 to December 2018,including 8 simple appendicitis(20%),25 suppurative appendicitis(62.5%),and 7 gangrenous appendicitis(17.5%).All patients underwent MSCT scanning before surgery.The manifestations of MSCT were analyzed in different pathological types of acute appendicitis in combination with clinical characteristics such as C reactive protein(CRP),procalcitonin(PCT),white blood cell(WBC)count and so on.Results:The CRP,PCT and WBC counts of gangrenous appendicitis group were higher than those of suppurative appendicitis and simple appendicitis group(P<0.05).The count of CRP,PCT and WBC in suppurative appendicitis group was higher than that in simple appendicitis group(P<0.05).In MSCT,gangrenous appendicitis is characterized by marked thickening of the appendix,local thickening of the intestinal wall,and surrounding pneumatosis.Among them,3 cases of high-density fecal shadows were disassociated from the appendix cavity into the abdominal cavity.Suppurative appendicitis appeared with appendix enlargement with fuzzy boundary and local patchy cord-like increased density.Simple appendicitis showed mildly swelling,the space around the appendix was slightly fuzzy,and a small amount of fluid density shadow was seen in the lumen.Conclusion:The MSCT scanning combined with CRP,PCT and WBC count has important guiding significance for the diagnosis of acute appendicitis of different pathological types.