腹部超声在小儿急性阑尾炎不同病理类型诊断中的价值

Value of abdominal ultrasound in diagnosis of different pathological types of acute appendicitis in children

目的探讨腹部超声在小儿急性阑尾炎(AA)不同病理类型诊断中的价值。方法回顾性分析我院2018年3月至2020年4月收治的94例AA患儿的临床资料,术前均行腹部超声检查,以手术病理结果为金标准,评估腹部超声诊断小儿AA分型的符合率、不同病理类型图像特点、诊断价值及诊断效能。结果83例经术后病理证实为AA的患儿中,80例经腹部超声检查提示AA,小儿AA分型诊断符合率为96.39%(80/83),二者差异无统计学意义(P>0.05)。腹部超声图像表现:急性单纯性阑尾炎,阑尾轻度肿大,阑尾直径增大≥0.60 cm,可见清晰的壁层结构,腔内多表现为均质点状低回声;急性化脓性阑尾炎,阑尾明显肿大,阑尾直径增大≥1.0 cm,黏膜下层断续,腔内以低回声为主的混合回声,阑尾周围见少量液性暗区包绕;急性坏疽性阑尾炎,阑尾肿胀显著,阑尾直径增大≥1.50 cm,阑尾壁结构不完整,黏膜下层断续、消失,腔内回声不均匀,部分伴粪石梗阻,周围网膜系膜增厚,阑尾周围可见不规则液性暗区。腹部超声诊断小儿AA的阳性预测值、阴性预测值、灵敏度、特异度、准确率为98.75%、71.43%、95.18%、90.91%、94.68%。腹部超声对小儿AA诊断的ROC曲线下面积为0.835(95%CI:0.760~0.891)。结论腹部超声对小儿AA在疾病诊断、病理分型诊断中具有较高的准确率。

Objective To investigate the value of abdominal ultrasound in the diagnosis of different pathological types of acute appendicitis(AA)in children.Methods The clinical data of 94 children with AA admitted to our hospital from March 2018 to April 2020 were retrospectively analyzed.Abdominal ultrasound examination was performed before operation.The coincidence rate of AA typing in children,image characteristics of different pathological types,diagnostic value and diagnostic efficiency of abdominal ultrasound were evaluated with surgical and pathological results as the gold standard.Results Of the 83 cases with AA confirmed by pathology,80 cases were diagnosed as AA by abdominal ultrasound.The diagnostic coincidence rate of AA classification in children was 96.39%(80/83),and there was no significant difference between the two methods(P>0.05).Abdominal ultrasound images showed acute simple appendicitis:slight enlargement of appendix,increase of appendix diameter≥0.60 cm,clear parietal structure,and homogeneous punctate hypoecho in cavity;acute suppurative appendicitis:the appendix was obviously swollen,the diameter of the appendix was increased by≥1.0 cm,the submucosa was intermittent,the cavity was dominated by mixed echo with hypoecho,and a small amount of liquid dark area was seen around the appendix;acute gangrenous appendicitis:the appendix was obviously swollen,the diameter of the appendix increased≥1.50 cm,the structure of the appendix wall was incomplete,the submucosa was intermittent and disappeared,the echo in the cavity was uneven,some of them were accompanied by fecal stone obstruction,the surrounding omental mesangium was thickened,and irregular liquid dark areas were seen around the appendix.The positive predictive value,negative predictive value,sensitivity,specificity and accuracy of abdominal ultrasound in the diagnosis of AA in children were 98.75%,71.43%,95.18%,90.91%and 94.68%,respectively.The area under ROC curve for abdominal ultrasound diagnosis of AA in children was 0.835(95%CI:0.760~0.891).Conclusion Abdominal ultrasound has a high accuracy in diagnosis and pathological classification of AA in children.